Internship Report Noor Arshad 28

CLINICAL NUTRITION INTERNSHIP
By
Noor Arshad
2019-GCUF- 073732
Internship Report submitted in partial

fulfillment of the requirements for the degree of
BACHELOR OF SCIENCE
IN
HUMAN NUTRITION AND DIETETICS
24th April, 2023 - 27th July, 2023

Gulab Devi Chest Hospital, Lahore
INSTITUTE OF HOME & FOOD SCIENCES

GC UNIVERSITY,
FAISALABAD
July 2023
DECLARATION
I Noor Arshad (Reg. No. 2019-GCUF-073732) hereby declare that the title Clinical
Nutrition Internship and the content of the internship report are the product of my own
training and no part has been copied from any publish source (except the references, genetic
models/equations/formula/protocols, etc.). I further declare that this work has not been
submitted for the award of any other degree. The University may take action if the
information provided is found inaccurate at any stage.
The work reported in this account was carried out by me under the supervision of Mr.
Mateen Ahmad at Gulab Devi Chest Hospital, Lahore and Gulab Devi Educational
Complex, Lahore, affiliated with Government College University Faisalabad, Faisalabad,
Pakistan. I also undertake that I will not publish this work without the consent of my
supervisor and I will be responsible for any plagiarism in this report.
Signature of the Student

Name: Noor Arshad
Registration No: 2019-GCUF-073732
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GULAB DEVI EDUCATIONAL COMPLEX, LAHORE
AFFILIATED WITH
GOVT. COLLEGE UNIVERSITY, FAISALABAD
CERTIFICATE BY SUPERVISOR
It is certified that the contents and form of the internship report submitted by
Noor Arshad , Registration No. 2019-GCUF-073732 has been found satisfactory and in
accordance with the prescribed format. It is recommended it to be processed for the
evaluation by the External Examiner for the award of degree.
Signature of Supervisor
Name: Mateen Ahmad
Designation with Stamp: Assistant Professor
Director/Chairperson Signature with stamp
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DEDICATION
I dedicate all my efforts and struggles in my educational life to Allah almighty , my dear
parents and my siblings , they are always a source of encouragement for me.
Also, I devote the work of this internship report to respectable and honorable director Dr.
Ruqayya Gull , Sir Mateen Ahmed, Miss Zunaira and all the teachers , who taught, rectified
my mistakes and supported me in developing my personality as a competent professional.
Noor Arshad
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ACKNOWLEDGMENT
First of all, I am profoundly grateful to Allah, the Most Compassionate and Most Merciful,
for guiding and blessing me throughout my academic journey and the completion of
Degree .I extend my sincere gratitude to the noble Prophet Muhammad (peace be upon him)
and his family , their teachings of wisdom, kindness, and perseverance continue to inspire my
actions and decisions in all aspects of life. I am privileged to express my heartfelt
appreciation to my esteemed academic supervisor, Mr. Mateen Ahmad. Your dedicated
guidance, unwavering support, and invaluable insights have played an instrumental role in
shaping my academic growth and research endeavors. Your mentorship has been a beacon of
light illuminating my path to knowledge. I would also like to thank the faculty members for
their commitment to excellence in education and for fostering an environment of intellectual
curiosity. Additionally, my gratitude extends to my family and friends for their unending
encouragement, understanding, and prayers. Your unwavering support has been my pillar of
strength throughout this journey. As I embark on new challenges and opportunities, I carry
with me the wisdom, knowledge, and values instilled in me during my time. With a heart full
of gratitude, I move forward, aiming to make meaningful contributions to society and uphold
the principles of knowledge, compassion, and integrity
Noor Arshad
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CONTENTS
1 CHAPTER 1......................................................................................................................1
1.1 INTRODUCTION OF HOSPITAL......................................................................1
1.2 DEPARTMENTS IN THE HOSPITAL................................................................1
2 CHAPTER 2......................................................................................................................3
2.1 DESCRIPTION OF INTERNSHIP.......................................................................3
2.2 GULAB DEVI EDUCATIONAL COMPLEX (GDEC)......................................3
2.3 HUMAN NUTRITION & DIETETICS................................................................3
2.4 WARD DUTIES / ROTATION PLAN.................................................................3
2.5 GOALS AND OBJECTIVES OF INTERNSHIP................................................4s

2.5.2 OBJECTIVES......................................................................................................4
2.5.3 INTERNSHIP CODE OF ETHICS:....................................................................4
2.6 ABBREVIATIONS AND TERMINOLOGIES:...................................................6
2.6.1 MEDICAL ABBREVIATIONS AND ACRONYMS:........................................6
2.6.2 TERMINOLOGIES:............................................................................................8
2.7 COMPETENCIES LEARNED DURING INTERNSHIP..................................10
2.7.1 INTRODUCTION..............................................................................................10
2.7.2 LEARNED COMPETENCIES..........................................................................10
3 CHAPTER 03..................................................................................................................14
3.1 CASE INDEXING AND DESCRIPTION..........................................................14
3.2 INDICES.............................................................................................................15
4 CHAPTER 4....................................................................................................................58
4.1 CONCLUSION...................................................................................................58
4.2 LEARNING OUTCOMES..................................................................................58
4.3 LIMITATIONS...................................................................................................58
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LIST OF TABLES
TABLE 2.1: Rotation Plan..................................................................................................3

TABLE 2.2: Medical Abbreviations & Acronyms.............................................................6
TABLE 2.3: Terms..............................................................................................................8
TABLE 3.1 Pediatrics Ward Index....................................................................................15
TABLE 3.2: Biochemical Data Of Pediatrics Ward..........................................................18
TABLE 3.3: Nutrient Drug Interactions Of Pediatrics Ward Index..................................19
TABLE 3.4 : Elaborated Pediatrics Ward Case.................................................................20
TABLE 3.5: Exchange Calculations And Meal Planning According To NUTRIENT DRUG
Interactions.........................................................................................................................21
TABLE 3.6: Diet Plan Of Pediatrics Ward Detailed Case.................................................22
TABLE 3.7 Pulmonology Ward Index..............................................................................23
TABLE 3.8: Biochemical Report Pulmonology Ward......................................................25
TABLE 3.9: Nutrient Drug Interaction Of Pulmonology Ward Index..............................26
TABLE 3.10: Detailed Case Of Pulmonology Ward.........................................................27
TABLE 3.11: Exchange Calculations And Meal Planning According to Nutrient Drug
Interactions.........................................................................................................................28
TABLE 3.12: Diet Plan Of Pulmonology Wards Detailed Case.......................................29
TABLE 3.13: Medical Ward Index....................................................................................30
TABLE 3.14: Biochemical Reports Pulmonology Ward...................................................32
TABLE 3.15: Nutrient Drug Interactions Of Medical Ward.............................................33
TABLE 3.16: Detailed Case Of Medical Ward.................................................................34
TABLE 3.17: Exchange Calculations And Meal Planning According to Nutrient Drug
Interactions.........................................................................................................................35
TABLE 3.18: Diet Plan Of Medicine Ward Detailed Case...............................................36
TABLE 3.19: Coronary Ward Index..................................................................................37
TABLE 3.20: Biochemical Reports Of Coronary Ward....................................................39
TABLE 3.21: Nutrient Drug Interactions Of Coronary Ward...........................................40
TABLE 3.22: Detailed Case Of Coronary Care Unit........................................................41
TABLE 3.23 : Exchange Calculations And Meal Planning According To Nutrient Drug
Interactions.........................................................................................................................42
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TABLE 3.24 : Diet Plan Of Coronary Care Unit Detailed Case.......................................43
TABLE 3.25: Surgery Ward Index....................................................................................44
TABLE 3.26 : Biochemical Data Of Surgery Ward..........................................................46
TABLE 3.27: Nutrient Drug Interactions Of Surgery Ward Medicines...........................47
TABLE 3.28: Detailed Case Of Surgery Ward Index........................................................48
TABLE 3.29: Exchange Calculations And Meal Planning According To Nutrient Drug
Interactions.........................................................................................................................49
TABLE 3.30 : Diet Plan Of Surgery Ward Detailed Case.................................................50
TABLE 3.31: Gynecology Ward Index.............................................................................51
TABLE 3.32 : Biochemical Test Reports Of Gynecology Ward Index............................53
TABLE 3.33 : Nutrient Drug Interactions Of Gynecology Ward Medicines....................54
TABLE 3.34: Detailed Gynecology Ward Case................................................................55
TABLE 3.35 : Exchange Calculations And Meal Planning According To Nutrient Drug
Interactions.........................................................................................................................56
TABLE 3.36: Diet Plan Of Gynecology Ward Detailed Case...........................................57
LIST OF FIGURES
FIGURE 2.1 : Stadio-Meter.....................................................................................................11

FIGURE 2.2: Mid-Upper Arm Circumference Tape...............................................................11
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FIGURE 2.3: Weighing Machine............................................................................................12
FIGURE 2.4: Head Circumference Tape.................................................................................12
FIGURE 2.5: Skin Fold Caliper...............................................................................................12
FIGURE 2.6: Flexible Segmometer.........................................................................................13
FIGURE 2.7: Measuring Tape.................................................................................................13
FIGURE 3.1: Ward Rotations..................................................................................................14
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Abbreviations And Terminologies:
Medical Abbreviations And Acronyms:
There are many more medical acronyms and abbreviations than what’s listed below. The
listed terms are learned in the internship:
Table 2.1: Medical Abbreviations & Acronyms
Medical Abbreviations and Acronyms

General Abbreviations: Pediatrics Ward:
a- or an- not or without BCG Scar - Bacille Calmette- Gurine
Abd - Abdominal/abdomen FM - Fetal movement
BP - Blood pressure GH - Growth hormone
Cap - Capsule HC - Head circumference
CBC - Complete Blood Count IDA - Iron Deficiency Anemia
CO2 - Carbon Dioxide IDM – Infant of diabetic mother.
DOB - Date Of Birth y/o - years old
F – Fahrenheit lbs. – Pounds
Hct - hematocrit Pulmonary Ward:
HDL - High-density lipoprotein cholesterol ARDS - Acute respiratory distress syndrome
HOB - Head of the bed CF - Cystic fibrosis
HTN - Hypertension EN – Enteral Nutrition
IM – Intramuscular COPD - Chronic obstructive pulmonary
IV – Intravenous disease
LDL-C - Low-density lipoprotein cholesterol ICU - intensive care unit
MCH - Mean corpuscular hemoglobin MDR-TB - Multidrug-resistant TB
MCHC - Mean corpuscular hemoglobin PEG - Percutaneous endoscopic gastrostomy
concentration SOB - Shortness of breath
MCV - Mean corpuscular volume T2RF - Type 2 Respiratory Failure
NKA - No known allergies TB – Tuberculosis
NKDA - No known drug allergies UGIB - Upper GI bleeding
NPO - Nothing by mouth URI - Upper respiratory infection
O2 - Oxygen Medicine Ward:
OPD - Outpatient department
APD - Acid peptic disease
OTC - Over the counter
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PT - Prothrombin time ATT - Anti-Tubercular treatment
Tab – Tablet CRP - C-Reactive Protein Test
WT – Weight DKA - Diabetic ketoacidosis
Surgery Ward: FUO - Fever of unknown origin
AS - Abdominal Surgery GERD - Gastroesophageal reflux disease
BS - Breast Surgery GFR - Glomerular filtration rate
CA - Cancer GI – Gastrointestinal
EGD – Esophagogastroduodenoscopy HAV - Hepatitis A virus
GOO - Gastric Outlet Obstruction HBV - Hepatitis B virus
Pre-op - Preoperative (before surgery) HCV - Hepatitis C virus
Post-op – Postoperative (after surgery) IBD - Inflammatory bowel disease
Gynecology Ward: IBS - Inflammatory bowel syndrome

PKD - Polycystic kidney disease
C/S - Cesarean section
PUO - Pyrexia of Unknown origin
EDD - estimated delivery date
SBO - Small bowel obstruction
LSCS - Lower segment Caesarian section
UTI - Urinary Tract Infection
GA - Gestational age
HA - Hemolytic anemia CCU Ward:
LBW - Low birth weight ABG - Arterial blood gas
PIH - Pregnancy-induced hypertension AMI - Acute myocardial infarction
PG – Pregnant Aptt - Activated partial thromboplastic

CABG - Coronary artery bypass graft
CCU - Coronary care unit; critical care unit
CHD - Congenital heart disease
CHF - Congestive heart failure
EKG - Electrocardiogram
HOA - Secondary Hypertrophic
Osteoarthropathy
HR - Heart rate, expressed as beats per
minute.
IHD - Ischemic heart disease
MRI - magnetic resonance imaging
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1.1.1 Terminologies:
These general medical terms are oftentimes abbreviated for ease of communication.
Table 2.2: Terms
Terms Definition
Abscess Accumulated pus that is surrounded by inflamed tissue.
Acute Signifies a condition that begins abruptly and is sometimes severe,
but the duration is short.
Adenopathy Also referred to as lymphadenopathy, is the swelling of lymph nodes.
Amenorrhea The absence of or cessation of menstruation.
Anemia The condition of having a lower-than-normal number of red blood
cells or quantity of hemoglobin
Anesthesia Loss of feeling or awareness, as when an anesthetic is administered
before surgery.
Anesthetic, Local An anesthetic that causes loss of feeling in a limited part of the
body.
Angina Chest pain due to an inadequate supply of oxygen to the heart
muscle.
Anthropometric Relating to the measurement of the physical characteristics of the
body, such as height and weight.
Aspiration Drawing in by suction or breathing; a common complication of
enteral feedings in which foreign material enters the lungs, often
from GI secretions or the reflux of stomach contents.
Belching The expulsion of gas from the stomach through the mouth.
Benign A growth that is not cancer. It does not invade nearby tissue or spread to
other parts of the body.
Blenderized Formulas enteral formulas that are prepared by using a food blender to mix
and puree whole foods
Breast Lump A localized swelling, knot, lump, bulge, or protuberance in the
breast. Breast lumps may appear in both sexes at all ages.
Breastfeeding When the mother after delivery feeds the baby breast milk, usually
directly from the breast. It’s also called nursing
Bronchitis Inflammation and swelling of the bronchi. Bronchitis can be acute
or chronic.
Carcinoma (Ca) Cancer begins in the skin or in tissues that line or cover body
organs. Examples are carcinoma of the breast, colon, liver, lung,
pancreas, prostate, or stomach
Cardiovascular Disease A general term for all diseases of the heart and blood vessels.
(CVD) Atherosclerosis is the main cause of CVD. When the arteries that
carry blood to the heart muscle become blocked, the heart suffers
damage known as coronary heart disease (CHD).
Cholecystitis Inflammation of the gallbladder, usually caused by obstruction of
the cystic duct by gallstones.
Cholelithiasis formation of gallstones
Chronic Signifies a recurring, persistent condition like heart disease
Constipation the condition of having infrequent or difficult bowel movements
Decongestant A drug that shrinks the swollen membranes in the nose, making it
easier for a person to breathe.
Dehydration The condition in which body water output exceeds water input.
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(Excessive loss of body water). Symptoms include thirst, dry skin
and mucous membranes, rapid heartbeat, low blood pressure, and
weakness.
Diabetes Mellitus A group of metabolic disorders characterized by hyperglycemia and
disordered insulin metabolism.
Dyspepsia It is a pain or an uncomfortable feeling in the upper middle part of
your stomach area. The pain might come and go, but it's there most
of the time.
Edema The swelling of body tissue caused by excessive amounts of fluid in
the interstitial spaces; seen in protein deficiency (among other
conditions).
Ekg Electrocardiogram, a way of monitoring the heart and testing for
problems.
Embolism An arterial blockage, often caused by a blood clot.
Ferritin the iron storage protein
fever It can be defined as any elevation of body temperature above the
normal level.
Gastritis It is a non-specific term meaning inflammation of the stomach
GERD Gastroesophageal reflux is the backflow of stomach acid into the
esophagus, causing damage to the cells of the esophagus and the
sensation of heartburn.
Gestation The period from conception to birth. For human beings, the average
length of a healthy gestation is 40 weeks. Pregnancy is often divided
into three-month periods, called trimesters.
Gestational Diabetes Abnormal glucose tolerance during pregnancy. A diabetic condition
that appears during pregnancy and usually goes away after the birth
of the baby or develops into diabetes type 2.
Viral Hepatitis It is widespread inflammation of the liver and is caused by various
hepatitis viruses including A, B, C, D, and E.
Hyperglycemia Elevated blood glucose concentrations. Normal fasting plasma
glucose is less than 100 mg/dL. Fasting plasma glucose from 100 to
125 mg/dL suggests prediabetes; values of 126 mg/dL and above
suggest diabetes.
Hypertension Also known as high or raised blood pressure, is a condition in which
the blood vessels have persistently raised pressure.
Hypoglycemia Abnormally low concentrations of blood glucose. In diabetes,
hypoglycemia is treated when plasma glucose levels fall below 70
mg/dL.
Indigestion Incomplete or uncomfortable digestion, usually accompanied by
pain, nausea, vomiting, heartburn, intestinal gas, or belching.
Inflammation A nonspecific response to injury or infection; a type of innate
immune response.
Intravenous Indicates medication or fluid that’s delivered by vein.
Lung Consolidation It occurs when the air that usually fills the small airways in your
lungs is replaced with something else, which may be replaced with: a
fluid, such as pus, blood, or water.
Malignant Indicates the presence of cancerous cells
Myocarditis It is a muscle layer of the heart inflamed
Polydipsia Excessive thirst.
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Polyphagia excessive appetite or food intake
Polyuria excessive urine secretion
Prediabetes The condition in which blood glucose levels are higher than normal
but not high enough to be diagnosed as diabetes.
Primary Amenorrhea It is menarche delayed beyond 16 years of age.
Prognosis The predicted outcome of disease progression and treatment
pyogenic It is involving or relating to the production of pus. ( Infections in
which pus is produced are known as pyogenic)
Secondary Amenorrhea It is the absence of three to six consecutive menstrual cycles
sputum It is also known as phlegm, is a thick type of mucus made in your
lungs, a mixture of saliva and mucus coughed up from the
respiratory tract, typically as a result of infection or other diseases
sutures Stitches, which are used to join tissues together as they heal
tube feedings Liquid formulas are delivered through a tube placed in the stomach
or intestine.
wasting The gradual atrophy (loss) of body tissues; associated with protein-
energy malnutrition or chronic illness.
wean To gradually replace breast milk with infant formula or other foods
appropriate to an infant’s diet.
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SUMMARY
Conducted during the final semester of the Bachelor of Science program in Human Nutrition
and Dietetics, the internship experience centered on delving into disease-related nutritional
issues and patient interaction. The internship took place at Gulab Devi Hospital, a prominent
medical institution in Pakistan known for employing advanced technologies and equipment in
the treatment of various ailments. Notably, the hospital prioritizes both patient well-being and
staff support. This report encompasses a historical overview, nutritional evaluations, case
studies from different hospital wards, and therapeutic approaches involving customized
recipes for diverse medical conditions. Beyond nutritional analysis, the report chronicles
personal internship insights and unveils forthcoming and revised dietary strategies. The
comprehensive medical nutritional therapy offered here incorporates recommendations and
guidance. Throughout the internship, I acquired proficiency in an array of specialties
including reproductive nutrition, oncology nutrition, pulmonology nutrition, medical
nutrition, coronary care nutrition, surgical nutrition, pediatric nutrition, intensive care
nutrition, and outpatient nutrition. A range of diets were practiced during the internship,
encompassing the DASH diet, Diabetic diet, Elemental diet, Elimination diet, Gluten-free
diet, Ketogenic diet, Low-FODMAP diet, Soft diet, Specific carbohydrate diet, clear liquid
diets, full liquid diets, no concentrated sweet diet, diabetic (calorie-controlled) diet, renal diet,
low-fat diet, high-fiber diet, and no added salts diet. Additionally, the internship provided the
opportunity to gain proficiency in anthropometric measurements, encompassing weight,
height, body mass index (BMI), body circumferences (arm, waist, hip, calf), waist-to-hip
ratio (WHR), elbow amplitude, and knee-heel length. To conclude, the internship assumes a
pivotal role in nutritional training, equipping students with hands-on expertise in managing
medical conditions through nutrition-focused care processes and medical nutritional therapy.
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2 CHAPTER 1
INTRODUCTION
2.1 BACKGROUND AND HISTORICAL FOUNDATION

Gulab Devi Chest Hospital was established in 1934 by British Indian politician Lala
Lajpat Rai in the memory of his mother, Gulab Devi, who died due to tuberculosis in 1927.
The semi-private tertiary care chest hospital started with 34 beds in 1934 and 50 beds in
1947. The Hospital has 1500 beds today. The cardiac wing began functioning in 1984 with
equipped angiography laboratory. Gulab Devi Hospital has been providing exceptional care
for the patients and their families since 1934 with passion and commitment.
The Hospital is a complete Unit and equipped with most recent equipment performing
all the cardiac diagnostic and therapeutic procedures in routine. In addition to the latest x-Ray
Machines and he Radiology department also possesses a Spiral CT Scan and almost all the
procedures are carried free of cost.
Gulab Devi Hospital
2.2 DEPARTMENTS IN THE HOSPITAL

Gulab Devi Hospital in Lahore, Pakistan, houses an array of specialized departments to
deliver comprehensive healthcare services. These departments cater to various medical needs
and conditions. Key departments include:
 Cardiology: Specialized in heart-related ailments and interventions.
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 Pulmonology: Addresses respiratory disorders like asthma and COPD.
 Thoracic Surgery: Focuses on surgical procedures involving the chest.
 Radiology: Provides imaging services for diagnosis.
 Pathology: Analyzes tissues and fluids for disease diagnosis.
 Gynecology and Obstetrics: Cares for women's reproductive health.
 Pediatrics: Dedicated to infant, child, and adolescent healthcare.
 Surgery: Offers diverse surgical interventions.
 Internal Medicine: Manages adult patients and chronic illnesses.
 Intensive Care Unit (ICU): Provides critical care support.
 Emergency: Handles urgent medical cases and trauma.
 Orthopedics: Focuses on musculoskeletal conditions.
 Nephrology: Specializes in kidney-related diseases.
 Neurology: Deals with nervous system disorders.
 Ophthalmology: Manages eye-related issues and surgeries.
 ENT (Ear, Nose, and Throat): Addresses disorders of these areas.
 Dermatology: Deals with skin conditions and surgeries.
 Physiotherapy: Offers rehabilitation and mobility enhancement.
..
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3 CHAPTER 2
3.1 DESCRIPTION OF INTERNSHIP

3.2 GULAB DEVI EDUCATIONAL COMPLEX (GDEC)
Excellence in education, research, and innovation are all hallmarks of the Gulab Devi
educational complex in Lahore. GDEC provides its pupils with a top-notch education. Its
goal is to create professionals with the best levels of training in creativity, professional
growth, and practise to deal with today's concerns. The GDEC develops its graduates into
future industry leaders who will motivate the younger generation and advance concepts with
a positive impact on the globe.
3.3 THE INSTITUTE OF HUMAN NUTRITION & DIETETICS
The Institute of Human Nutrition & Dietetics (IHND) was established in the year 2016
as a significant addition to the Gulab Devi Educational Complex (GDEC). This institute
stands as a testament to the complex's commitment to holistic healthcare, focusing on the
crucial aspect of nutrition and dietetics in overall well-being . Faculty and students engage in
research projects that address critical nutrition-related issues, contributing to the
understanding of dietary habits, nutritional deficiencies, and the role of nutrition in disease
prevention and management.
Purpose
The Human Nutrition and Dietetics internship at Gulab Devi Hospital provides aspiring
nutritionists and dietitians with practical exposure to clinical settings, allowing them to apply
their academic knowledge in assessing patients' nutritional needs, designing tailored diet
plans, and collaborating within interdisciplinary healthcare teams. Through this internship,
interns gain invaluable hands-on experience in patient care, develop effective communication
skills, and contribute to the promotion of evidence-based nutritional practices while fostering
personal and professional growth within a diverse medical environment
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3.4 WARD DUTIES / ROTATION PLAN
Table 2.3: Rotation Plan
GROUP 4
Date Wards
24-04-2023 – 03-04-2023 Pediatrics
08-05-2023 – 20-04-2023 Pulmonary
22-05-2023 – 03-06-2023 General Medicine Unit 1&2
05-06-2023 – 17-06-2023 Cardiology
19-06-2023 – 08-07-2023 Surgery
10-07-2023 – 22-07-2023 Gynecology
3.5 OBJECTIVES OF INTERNSHIP

3.5.1 Objectives :
 Apply theoretical knowledge in practical clinical settings.
 Develop competence in nutritional assessments and personalized diet planning.
 Learn effective collaboration within interdisciplinary healthcare teams.
 Enhance communication skills through patient interactions and counseling.
 Understand patient-centered care and individualized interventions.
 Engage in research, education, and community outreach initiatives.
 Foster personal and professional growth in a real-world healthcare environment.
 Promote health awareness and preventive measures in the community.
 Build valuable networking opportunities with experienced professionals.
3.5.2 INTERNSHIP CODE OF ETHICS:
Every student should follow the following SOPs strictly;

 Respecting the institute's and the hospital's policies and procedures is something that
every student should do.
 Quickly assessing patients in the outpatient, emergency, and inpatient departments
(including the recovery area and the intensive care unit) and wards and documenting
pertinent data.
 Taking part in departmental educational activities, such as morning meetings, rounds,
mortality conferences, and so on, to stay informed .
 Required to wear a lab coat.
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 Consulting the resident or attending physician on the management of the patient and
ensuring that the agreed-upon management is carried out .
 Long hair must be kept back; when on rotations, avoid eating and drinking in the hospital.
 Use proper questioning strategies to determine an accurate nutritional diagnosis.
 Conduct a thorough and precise physical exam.
 Behave professionally and dress appropriately.
 Understand how to use equipment before using it.
 Never use equipment unless you are completely familiar with how to use it;
 Always put all tools and supplies back where they came from.
 Use all the resources available to you in evidence-based medicine to make decisions
about management, diagnosis, and therapy that are supported by good logic.
 Be sensitive when providing inpatient care by treating each patient as an individual while
taking into account their age, culture, disability, education, ethnicity, gender, race, and
religion.
 Communicate effectively with patients and families from a variety of socioeconomic and
cultural backgrounds.
 Recognise your training's limitations and ask for support if needed.
 Construct a nutritional management strategy using clinical reasoning techniques to
interpret data.
 When asking for a consultation, be sure to ask a specific clinical question.
 While doing an internship at a hospital, students should make an effort to conduct all
tasks in a professional and ethical manner.
3.6 COMPETENCIES LEARNED DURING INTERNSHIP

3.6.1 Introduction :
In order to practise dietetics, entry-level practitioners must possess a certain set of
knowledge, talents, skills, and capacities as well as the requisite judgement, attitudes,
and values. Competency statements outline the performance behaviour and attitude of
entry-level practitioners based on the necessary knowledge, aptitude, capability,
skills, judgement, perspectives, and values.
3.6.2 Learned Competencies:

• Acquired the capacity to recognise nutrition-related problems and select the most
appropriate nutrition therapies
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• Analytical abilities were created for analysing anomalous test results and identifying
the root reasons, such as nutritional deficiencies, medication interactions involving
nutrients, or the outcome of a particular clinical condition.
• In the clinical nutrition setting, I learned how to develop and implement a patient
nutrition care plan that is based on the identification and assessment of a patient's
nutritional needs, as well as other health plans.
• Interpersonal skills (Effective communication, Critical Thinking & Problem
Solving abilities) were established during the internship to provide nutrition guidance
to patients and their families.
• Acquired knowledge of how to gather information from historical records, physical
examinations, and anthropometric calculations, as well as how to evaluate this
information to determine nutritional requirements. The following instruments were
used for anthropometric measurements:
Figure 2.1 : Stadio-meter
Stadio-meter: it is used to measure height.
Figure 2.2: Mid-Upper Arm Circumference Tape
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Mid-upper arm circumference tape (MUAC tape): it is used to measure the nutritional
status of children from the age of 12 months up to the age of 59 months
.
Weighing Machine
Figure 2.3: Image Courtesy (
Weighing machine: it is used to measure the body weight to check either the patient is
underweight or overweight.
Figure 2.4: Head Circumference Tape
Head circumference Tape: Head circumference is measured because it's an easy way to tell
if there's a potential problem or if something needs to be watched. For example, if the head
grows too fast, it could sign hydrocephalus or water on the brain. If the head grows too
slowly, it could be a sign of microcephaly or a smaller head than normal.
Figure 2.5: Skin Fold Caliper
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Skinfold caliper: is used to assess the skinfold thickness, so that a prediction of the total
amount of body fat can be made. This method is based on the hypothesis that the body fat is
equally distributed over the body and that the thickness of the skinfold is a measure for
subcutaneous fat.
Figure 2.6: Flexible Segmometer
Flexible Segmometer: it is used to measure knee height when patient is unable to

stand.
Figure 2.7: Measuring tape
Measuring tape: it is used to measure wrist circumference which is used for the
calculation of frame size.
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4 CHAPTER 03
4.1 CASE INDEXING AND DESCRIPTION

During the internship program patient data were taken by visiting below mentioned wards by
Pediatrics
Pulmonology
Wards Medicine
Cardiology
Surgery
Gynecology
interacting patients. A standard operating procedure (SOP) including mask, scrub and gloves
was followed during ward rotation. Patient data collection was done by filling assessment
proforma including anthropometric measurements, biochemical analysis, dietary assessment
and by assessing clinical sign and symptoms.
Figure 3.8: ward rotations
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4.2 Indices
TABLE 3.4: Pediatrics Ward Index
PATIENT DATA (PEDIATRICS)

Sr. patients Medical / Concerned Nutritional Diet Order Nutrition Education
No. name (age) Nutritional Nutrition Assessment
Diagnosis Intervention
1 Name: Emphysema / Increased caloric Height for age: Calorie dense along • Calorie dense foods such as tortilla,
Minahil lung abscess intake, <3rd percentile with high protein meat, beef, chicken, corn oat meal, rice.
Age: 6 year Nutrient dense (normal) and micronutrient • Fluids like juices (mango, apple,
Gender: foods are added BMI for age:12.4 kg/m2 rich foods peaches, plum,) and soups (chicken soup,
Female Fluids:1.2 liters (below 3rd percentile) Carbohydrate: 157 g lamb and lentil soup) etc.
are added (low BMI for age) Protein: 87g • Zinc sources: Whole grain foods,
16
Zinc: 8mg/d Wt. for age: Fat: 46 g fortified cereals. Cooked beans, cheese,
Vit D :600 IU/d <3rd percentile Calories : 1400 kcal oatmeal, cashews and almonds.
Vit A :600 mcg/d (underweight) • Vit. D: Vitamin D-fortified products
Niacin : 45mg/d like plain whole cow's mik , yogurt,
cereals, and some 100% juices.
2 Name: Abdominal TB / Nutrient dense Height for age: Low CHO diet along • Nutrient dense foods such as cerelac,
Najmul GI Bleed food recipes are <3rd percentile with nutrient dense minced meat, minced chicken breast,
Hassan Excessive added (normal) foods and adequate (BF3 milk servings 5-7 a day), mashed
Age: 6 year. calorie intake Cut down Weight for age: fluid intake banana, water melon, Mellon etc.
Gender: Dehydration excessive calories <3rd percentile Carbohydrate: 143g • Vitamin D-fortified products like plain
Male Micronutrient Fluid : 1.3 liters (underweight) Protein: 47g whole cow's milk (for children 12 months
deficiency VIT. D:600 IU/d BMI for age : Fat: 21g and older), yogurt, cereals, and some
VIT.C : 50mg/d >3rd percentile Calories : 755kcal 100% juices.
Potassium: 3mg/d (normal) • Vit.C: Breast milk, infant formula, and
Sodium : 1.9 mg/d whole foods, such as bell pepper,
B6: 0.4mg/d strawberries, and papaya are the best
B12: 0.5mcg/d sources of vit. C.
Sr. Patients Medical / Concerned Nutritional Diet Order Nutrition Education
No. Name (Age) Nutritional Nutrition Assessment
3 Name: Momna (L) Increased caloric Wt. for age: Calorie dense diet • Calorie-dense foods such as
Waqas Emphysema / intake, <3rd percentile along with high protein cerelac, minced meat, minced
Age: 13 years Post Add Nutrient dense Height for age: and nutrient dense chicken breast, (BF3 milk servings
Gender: Female Pneumonia food recipes, <50th percentile foods 5-7 times a day), mashed banana,
Malnutrition 3times a day. Bmi for age : Carbohydrate: 168 g water melon, Cantaloupe etc.
Calcium:700mg/d <50th percentile Protein: 112g • Ca sources: Ca fortified Milk and
Zinc: 2mg/d (underweight) Fat: 22.2g Milk products. Cow’s milk, buffalo
Vit. D:600IU/d Calories : 41 kcal milk, goat milk can be started after 1
Vitamin E: 4mg year of age,
• protein sources: chicken , meat ,
eggs , lentils .
4 Name: Sumbul Cervical Add 300 calories in BMI for age: Calorie dense Diet • Calorie Dense foods for fever:
17
Age: 12 years lymphodenopa- total energy <3rd percentile along with high fiber poultry broths, thin soups, coconut
Gender: Female thy / expenditure, iron Wt. for age: and iron rich foods water.
consolidation rich foods , fluids <3rd percentile • Milk shake: Mango, Banana
lung / are added up to Ht. for age: Carbohydrate: 170g, Fruit juices: Apple, guava, Mango
Iron deficiency 1200 ml , <3rd percentile Protein: 113g, Peach, pear etc.
anemia, Vitamin (underweight ) Fat: 42g, • Iron sources
undernourished C :45mg/d Calories : 1515kcal Heme( Beef, poultry, and seafood)
Constipated Iron : 40mg/d Non- Heme(dried beans and peas,
Zinc: 8mg/d dried fruits, leafy dark green
vegetables, iron-fortified breakfast
cereals and breads)
• fiber rich foods lentils, chickpeas ,
carrots , wheat , bran cereals ,
banana .
No Name Nutritional Nutrition Assessment
. (Age) Diagnosis Intervention
5 Name: Intermittent Add soft and BMI for age: Brat diet along with •Nutrient dense foods such as
M.Maaz fever / diarrhea, bland food in >25th percentile micronutrient rich tortilla, meat, beef, chicken, corn
Age: 11years vomiting, the meal Wt. for age: foods oat meal, rice.
Gender: anorexia Nutrient dense >25th percentile Carbohydrate: 206g •Fluids like juices (mango, apple,
Male foods are added Ht. for age: Protein: 93g peaches, plum,) and soups
Fluids:1.7 liters >50th Fat: 33g (chicken soup, lamb and lentil
are added percentile(normal) Calories : 1540 kcal soup) etc.
Zinc : 23mg/d •Vit C: citrus fruit ,bell pepper,
Vit.C: 45mg/d broccoli papaya , pineapple ..
Iron : 40mg/d IRON : peas , green leafy veggies ,
liver , nuts , lentils , pumpkin .
18
BIOCHEMICAL DATA (PEDIATRICS)
Sr. Name Test Patient Normal Values Health Interpretation
No. Test
Result
1 Minahil Hb 8.3 ↓ 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow failure, or
renal disease or who are taking certain drugs
Female ESR 112 ↑ 1–20 mm/hr An extremely high ESR value, which is one above 100 mm/hr, may indicate one of these
conditions: multiple myeloma, a cancer of plasma cells.
CRP (+) 3.5 – 5.2 g/dL A high level of CRP in the blood can be a marker of inflammation.
2 Momna Hb 10.8 ↓ 13.2-16.6g/dL
↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow failure, or
female ESR 58 ↑ 1-20mm/hour ESR values of 40 and 60 mm/h clearly indicate a state of heightened systemic
inflammation among people who already have an inflammatory disease.
TLC 15.7 ↑ 4-11g/dL It usually means you have infection or inflammation in your body.
19
3 M.Maaz Hb 9.8 ↓ 12 -15.5g/dl If you have a lower albumin level, you may have malnutrition.
BU 0.7↓ 6-12g/l Low level of blood urea indicates that your kidney may not working properly
male SGOT 145 ↑ 10 – 30 U/L High level indicates that you may have liver damage or other organs .
ESR 51↑ 1–20 mm/hr ↑indicate a more “active” disease, such as cancer, diabetes, or cardiovascular disease.
RBC 4.6↓ 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow failure, or
MCH 29↓ MCH: 27 to 31 Common conditions resulting in a hypochromic microcytic anemia (low MCV and MCH)
picograms/cell. include thalassemia and iron deficiency
4 Sumbul Hb 9.4 ↓ 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow failure, or
Female MCV 81 fl↓ 80–100 fl Low MCV means that red blood cells are smaller than normal and may indicate
microcytic anemia.
MCH 26 ↓ MCH: 27 to 31 Common conditions resulting in a hypochromic microcytic anemia (low MCV and MCH)
picograms/cell. include thalassemia and iron deficiency
5 Najmul Hb 10.2 ↓ 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow failure, or
Male renal disease or who are taking certain drugs
. TABLE 3.5: BIOCHEMICAL DATA OF PEDIATRICS WARD
2
TABLE 3.6: NUTRIENT DRUG INTERACTIONS OF PEDIATRICS WARD INDEX
Nutrient Drug Interactions

Drug Drug Effect Nutritional Implications and Cautions
Vidaylin (multivitamin) Constipation , diarrhea , upset stomach . these Take with food to lower GI distress. Use mouth rinses,
symptoms will be cure within time when body fresh mint, or lemon water for dysguesia. Replace fluids
get use to the medication & electrolytes for diarrhea. Avoid alcohol. Probiotic is
advised.
Arceva Headache , dizziness muscle or joint pain , Avoid grape fruit
difficulty falling sleep . it may cause abdominal High fiber foods should not be consumed . taking drug
pain . with milk will be benificial
PEDIATRICS WARD MEDICINES
Syrup Drug may cause hepatotoxicity at high dose. Maximum safe adult dose is 3 g/day Avoid alcohol or
Calpol(paracetamol) Chronic alcohol ingestion increases risk of limit to 2 drinks/day.
hepatotoxicity.
Ceftriaxone (antibiotic) It works by stopping the growth of bacteria. Take with a meal for optimal bioavailability. Take
20
Food increases bioavailability of tablets and separately from antacids, Ca, or Mg supplements.
suspension. Antacids, Ca, and Mg supplements Probiotic may be advised
may decrease bioavailability.
Zingat OD Rashes , swelling redness with or without fever. Take drug with 8 oz. of fluid and maintain adequate
It may cause heartburn , weakness or nausea . hydration. Limit caffeine intake.
Inj. Fortum Nervousness, shaking (tremor), headache, It can interfere with the activity of folic acid and vit. B1.
mouth/throat dryness or irritation, changes in Taking drug with food may not cause any side effect
taste, cough, nausea or dizziness may occur.
Deltacortrip Infection, Weight gain, Indigestion, These medications interact with Deltacortrip
Sleeplessness, Mood swings, Confusion, antibiotics, such as clarithromycin, erythromycin,
Weakness, Fatigue. rifabutin, rifampin, or troleandomycin.
Anticholinesterases, such as neostigmine, or
pyridostigmine.
Anticoagulants (blood thinners) such as apixaban,
dabigatran.
S.N 01 NUTRITIONAL ASSESSMENT (PEDIATRICS)
OBJECTIVE DATA SUBJECTIVE DATA
Anthropometric Data Biochemical Data Results Status Clinical Data
HEIGHT (FEET’ 3’9’’ Hb (g/dL) 10.2 low Current Diagnosis Abdominal TB / GI Bleed / IDA
INCHES”)
ABW (KG) 20 BU (mg/dL) 18 Normal Previous Med History Fever
UBW (KG) - S. Creatinine (mg/dL) 0.5 low Family History TB (+), Asthma
NAME OF PATIENT
%UBW - Bilirubin T. (mg/dL) 07 Low Social History Socioeconomic Geographical Occupation

Najmul Hassan
status location
(27-05-2023)
IBW (KG) 21 SGPT (u/L) 18 Normal Middle class Urban Employ (father)
(DATE)
%IBW - SGOT (u/L) 25 High Physical Examination Anorexia, inappropriate food choices, constipation
% Weight Change - ALP (u/L) 453 Normal Dietary Data Status
Wrist Circ. (cm) - Albumin (g/dL) - - Energy Intake (Kcal) 1960 High
Goal Weight (kg/M) Sodium (mmol/L) 135 Low CHO Intake (g) 240 47 % High
BMI 15.01 <3rd Potassium (mmol/L) 3.0 Low Protein Intake (g) 82 16 % Low
percentile Chloride (mmol/L) 105 Normal Fats Intake (g) 52 23 % Normal
Frame Size - - APTT 30.6 High Saturated Fats (g) - -
Pt. 25 High Unsaturated Fats (g) - -
Nutrition Diagnosis Diet Order Gluten Free Diet Medical Nutrition Method
21
Nutrition Intervention Therapy used

Anorexia Meal Planning according to calorie and nutritional requirements through portion sizes. This diet contains Energy (Kcal) 1309 WHO
Carbohydrates (146g), a moderate amount of Fats (36g), and proteins (98g)
Excessive calorie intake Avoid meal with high calories . Cut down calories with time interval . add food from good food sources Carbohydrates 45 AMDR
which fulfill the need . (%)
Iron deficiency anemia Add iron rich food items . food which are high in iron like green leafy veggies , nuts , lentils Proteins (%) 30 AMDR
Fats (%) 25 AMDR
Fluids (L) 1.2 L 1mL/Kcal
PES STATEMENT Iron deficiency anemia related to less intake of iron rich food in the diet as evidence by dietary recall .
DIETARY INSTRUCTIONS(safe choices)
Bread & Cereals: Consume whole grains , arrowroot, bean flours, boiled rice, sorghum, tapioca.
Meat & Proteins: Any type of plain cocked eggs, fresh meat, fish, shellfish or poultry, vegetable broth etc.
Fruits: Consume Apricot, Apple, Avocado, Banana, Grapefruit, Guava, strawberries in moderate quantity
EDUCATION
NUTRITION
Vegetables: Any plain fresh, canned, frozen vegetables, including corn, peas, beans, etc.
Milk & Dairy: Any plain unflavored milk or yogurt, cream, cheese.
Fats & Oils: Butter, margarine, all pure vegetable oils (including canola), mayonnaise, cream
Herbs: Any plain herb or spice; salt; pepper; brown or white sugar; or artificial sweetener .
GENERAL GUIDELINES
• Management of other co-morbid conditions • Add fruit and vegetables high in iron • Vitamin and mineral supplementation
• monitor fluid intake • Supplementation with ω-3 fatty acids • high fiber food to deal with constipation .
TABLE 3.7ELABORATED PEDIATRICS WARD CASE

TABLE 3.8: EXCHANGE CALCULATIONS AND MEAL PLANNING ACCORDING TO NUTRIENT DRUG INTERACTIONS
Food Groups Exchanges Carbohydrates Protein Fats Calories
Milk (Low Fat) 2 24 16 2 200
Milk (Reduced Fat) 0 0 0 0
Milk (Whole) 0 0 0 0 0
Non Starchy vegetables 2 10 4 50
Starch 0 0 0 0 0
Starchy vegetable 0 0 0 0 0
Fruits 4 60 240
Total 94 20
Remaining CHO 5
Bread & cereals 5 75 15 5 400
Total
22
Remaining proteins 4
Proteins (very lean) 0 0
Proteins (lean) 3 21 3 135
Protein (medium fat) 0 0 0 0
Protein (high fat) 0 0 0 0
Plant based proteins 1 15 10 1.5 125
Total 199 71 12.5 1230
Remaining fats 5
Fats 5 25 225
Total 145g 95g 35g 1375kcal
Drug Names Drug Effect Nutrition care and caution
Zingat OD Zingat OD Tablet is used to treat Take with or without food. The absorption is
diarrhea and zinc deficiency. unaffected by food
Inj . Fortum It acts by either killing or Take with a meal for optimal bioavailability. Take
inhibiting the growth of the separately from iron or folic acid supplements.
bacteria . Probiotic may be advised.
TABLE 3.9: DIET PLAN OF PEDIATRICS WARD DETAILED CASE
Diet Plan
Meal Timings Portion Size Food Items
Pre-Breakfast  1 tbsp  Sunflower seeds
(7:00 -7:30) am  1 glass  water
Breakfast  1(12inch )  Vegetable wrap
 1  Egg
(8:00 – 9:00)am
 1 cup  Milk
Mid-Morning Snacks
 1  Apricot
(11:00 – 12:00) am
23
Lunch  2  Boiled rice

 1/2 cup  Peas
(1:30 – 2:30)pm
 1 cup  Lentil soup
Evening Snacks  1  Spinach muffin
(4:00 – 5:00)pm  (banana+spinach+egg+milk)
Dinner  1  Chapatti
 1/2 cup  Eggplant ( cooked)
(7:30 -8:30)pm
 1oz  Steamed chicken
Before Bed  2cups  Popcorn
(10:30 -11:00)pm  1 cup  Juice (apple)
Note: Take medicines with or without food, because their absorption is unaffected by food.
Avoid taking antibiotics with milk and calcium supplements.
TABLE 3.10 PULMONOLOGY WARD INDEX
PATIENT DATA (PULMONOLOGY)

No. Name Nutritional Nutrition Assessment
(Age) Diagnosis Intervention
1 Name: Post tuberculosis / Increased caloric Height: 5̍ 5 High Calorie & • Calorie-dense foods such as
Neelum LRTI intake, Weight: 25kg nutrient Dense tortilla, meat, beef, chicken, corn oat
Age: 45years Inadequate nutrient Nutrient dense BMI: 9 kg/m2 diet along with meal, rice.
Gender: intake, foods are added (underweight) anti- • Fluids like juices
female Dehydration Fluids:2 liters are IBW: 56kg inflammatory (mango,apple,peaches,plum,)and
24
Malnourished(severe added Goal wt.: 70 foods soups (chicken soup, lamb and lentil
) Frame size: 11.04 Carbohydrate: soup) etc.
(small) 172g Anti inflammatory foods: green
Protein: 68g tea,leafy veggies, olive
Fat: 42g oil,walnuts,berries,fish.
Calories :
1380kcal
2 Name: Azra Disseminated TB / Caloric intake is Height: 5̍ ̎3 Calorie dense • Iron rich foods (apricot,peach,kale
Bibi Ascites / Pedal increased, Iron rich Weight: 40kg and sodium canteloup,spinachpotato,carrot)
Age: Edema foods, Nutrient BMI: 15.39 kg/m2 restricted Diet • Calorie-Dense foods (egg, sweet
35years. Malnutrition dense food recipes (underweight) with iron rich potato, lentils, beans, whole
Gender: Iron deficiency are added. IBW: 52kg foods grains,tortilla,porridge)
female Fluids : 1 liter Goal wt.: 50 Carbohydrate: Low sodium food :dry peas and
fluids are added Frame size: 246g, beans , unsalted seeds and nuts , plain
11.4(small) Protein: 162g, yogurt .
Fat: 61g,
Kcal: 2000kcal
3 Name: Parvaiz Post Foods with good fat Height: 5̍ 4 ̎ Consistent carbs diet • Iron rich foods(apricot,peach,kale
Age: 62 years. Tuberculosis/ DM content are added in Weight: 43kg with iron rich foods canteloup,spinachpotato,carrot)
Gender: Male iron deficiency diet, Iron rich foods BMI: 16 kg/m2 and adequate fluid • Zinc rich fruits and vegetables
anemia , also included (underweight) intake (beet root, peach, apple, mango, pear)
dehydration Fluid : 2L is required IBW: 55kg Carbohydrate: 157g • Calorie-dense foods (egg, sweet
Inadequate fat to deal with Goal wt.: 50 Protein: 62g potato, lentils, beans, whole grains,
intake dehydration Frame size: Fat: 41g tortilla, porridge).
10.1(medium) Calories : 1260kcal Fluid: fresh fruit and vegetable
juices , broth , herbal tea.
4 Name: Tuberculosis Add calorie dense Height: 5̍ 3 ̎ Calorie dense diet • Calorie dense foods:oatmeal ,
M.Rafiq Asthma , food and recipes Weight: 53kg along with high porridge , boiled rice , sweet
Age: 57 years. Iron deficiency , Protein portion in BMI: 17kg/m2 protein and iron rich potato ,meat , whole grains .
25
Gender: Male Dehydration, every meal (overweight) food plan Iron rich foods : green leafy
underweight Iron rich foods IBW: 63kg Carbohydrate: 160g vegetable , pumpkin , beans ,
Fluid :1.8 Liters Goal wt.: 60 kg Protein: 100g lentils ,liver .
Frame size: Fat: 35g
10.7(small ) Calories : 1430kcal
5 Name: Esha Pulmonary Increased caloric Height: 5̍ 1 Nutrient &calorie •Iron rich foods: Beetroot, mixed
Age: 16 years. Tuberculosis/ intake, iron rich foods Weight: 30kg dense diet with iron beans, baked beans, lentils,
Gender: Dehydration, iron with vitamin C BMI: 12 kg/m2 rich foods chickpeas,
female deficiency supplementation, (underweight) Carbohydrate: 216g • Calorie dense foods (oat meal,
anemia, Fluids up to IBW: 50kg Protein: 144g potato, tomato, spinach, whole wheat
underweight 1.5ml/kcal Goal wt.: 44 Fat: 53g products).
Frame size: 12.8 Calories : 1900kcal • Fluid intake up to 1.5ml/kcal is
(small) recommended to prevent dehydration.
.
TABLE 3.11: BIOCHEMICAL REPORT PULMONOLOGY WARD
BIOCHEMICAL DATA (PULMONARY I & II)

No. Test
Result
1 Rafiq Hb 9↓ male, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
failure, or renal disease or who are taking certain drugs
SGOT 41 ↑ male; 0.4 – 1.0 mg/dL ↑ levels indicate one of the organ or muscles containing the enzyme could be
damaged
2 Esha Hb 7.5 ↓ Female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
3 Pervaiz Hb 11.7 ↓ male, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
26

SGOT 18↑ male; 8-45units/liter of ↑ levels indicate one of the organ or muscles containing the enzyme could be
serum damaged
Mch 25 ↓ Male , 26-33 pg Low level of Hcv indicates that your hemoglobin production is less than normal
4 Neelum Hb 6.5 ↓ Female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
5 Azra bibi Hb 9↓ Female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
Na 131 ↓ Female 135 and 145 A low sodium level has many causes including consumption of too many fluids,
(mEq/L) kidney failure, heart failure, cirrhosis
SGOT 43↑ Female; 0.4 – 1.0 mg/dL ↑ levels indicate one of the organ or muscles containing the enzyme could be
damaged
TABLE 3.12: NUTRIENT DRUG INTERACTION OF PULMONOLOGY WARD INDEX

Inj, Transamin Drug may rarely precipitate in the blocking of blood Take drug with 8 oz of fluid and maintain adequate
clots . it helps to treat bleeding .competitively hydration. Limit caffeine . it also interact with birth control
inhibits the activation of plasminogen to plasma . tablets . take it without food .
PULMMONOLOGY WARD MEDICINES
ceftriaxone (Rocephin) Food will increase bioavailability of tablets and Take with a meal for optimal bioavailability. Take
suspension. It works by changing the brain and separately from antacids, Ca, or Mg supplements.
nervous system responds to pain . Probiotics may be advised.
Ibert folic acid Interact with moxifloxacin Take it after eight hours of drug moxifloxacin
administration. Avoid milk with medicine
Cap. Tramal Long-term use may lead to oral candidiasis, Use caution with low-sodium diet or potassium
diarrhea, and epigastric distress. It can slow or stop supplements. Augmentin: take with food to lower the GI
27
your breathing or maybe habit- Forming . distress. Replace fluids & electrolytes for diarrhea.
Probiotic is advised.
Leflox(levafloxacin) Drug will bind to magnesium, calcium, zinc, and Take drug with 8 oz of fluid and maintain adequate
iron, forming an insoluble, unabsorbable complex. hydration. Limit caffeine intake. Take at least 4 hours
May cause Clostridium difficile. before or 8 hours after antacids, Mg, Ca, Fe, Zn
supplements or multivitamin with minerals. Replace fluids
& electrolytes for diarrhea. Hold tube feeds 1 hour before
and 1 hour after drug. Probiotic is advised.
Risek (omeprazole) Long-term acid secretion may inhibit the absorption Monitor iron studies, vitamin B12, magnesium levels, and
of iron and vitamin B12; decrease calcium bone density with long-term use; supplement as needed.
absorption may lead to osteoporosis. Low Mg may Consider alternatives in those with a diagnosis of SIBO
occur. and/or IBS
Glucophage It helps to control blood sugar levels . It is used together with diet and exercise to improve blood
sugar .
TABLE 3.13: DETAILED CASE OF PULMONOLOGY WARD
S.N 02 NUTRITIONAL ASSESSMENT (PULMONOLOGY)
HEIGHT (FEET’ 5’3’’ Hb (g/dL) 9 low Current Diagnosis Tuberculosis ,Ascites
INCHES”)
ABW (KG) 40 BU (mg/dL) 26 Normal Previous Med History Significant weight loss 58kg to 40(lost 15kg weight
UBW (KG) 58 S. Creatinine (mg/dL) 0.6 Normal Family History Diabetes (-),tuberculosis(+), Celiac disease(-)
NAME OF PATIENT
%UBW 80% Bilirubin T. (mg/dL) - - Social History Socioeconomic Geographical Occupation

status location TA
(15-05-2023)
IBW (KG) 52 SGPT (u/L) - - Middle class Urban Labour (Husband) BL

Azra bibi
(DATE)
%IBW 67.7% SGOT (u/L) 43 Normal Physical Examination Anorexia, inappropriate food choices
E
% Weight Change -29% ADA 137 High Dietary Data Status
Wrist Circ. (cm) 15 MCV 80 Low Energy Intake (Kcal) 1390 Low 3.1
Goal Weight (kg/M) 50 MCH 26 Low CHO Intake (g) 186 53 % Normal 4:
BMI 15.6 Underweight Potassium (mmol/L) 141 Normal Protein Intake (g) 51 14 % Low
Chloride (mmol/L) 3.9 Normal Fats Intake (g) 41 27 % Low
Frame Size 11.4 Small APTT - - Saturated Fats (g) - -
Pt. - - Unsaturated Fats (g) - -
28
Nutrition Diagnosis Diet Order Sodium restricted diet along with high protein and iron rich foods Medical Nutrition Therapy Method
Nutrition Intervention used
Anorexia Meal Planning according to calorie and nutritional requirements through portion sizes. This diet contains Carbohydrates (211g), Energy (Kcal) 2000 HBE
a moderate amount of Fats (65g), and proteins (63g).
Inappropriate food choices Always choose calorie dense and nutrient dense foods, with soft consistency and mildly seasoned. Carbohydrates (%) 48 AMDR
Iron deficiency anemia Always choose iron rich foods like beet root, read beans and peaches. Proteins (%) 25 AMDR
Inadequate protein intake Add protein rich food items in every meal of the day to improve the deficiency Fats (%) 27 AMDR
Fluids (L) 1 1mL/Kcal

PES STATEMENT Iron deficiency anemia is related to less intake of iron rich foods as evidenced by biochemical test reports.

Bread & Cereals: Consume Whole wheat Flour, legumes, Rice Boiled, Jowar, Bajra, porridge & oatmeal.
Meat & Proteins: Consumes Chick peas, lentils, legumes, use animal protein sources in controlled portions.
Fruits: Consume Apricot, Apple, Avocado, Banana, Grapefruit, Guava, coconut water, grapes in moderate quantity.
Vegetables: Any plain fresh, broccoli pumpkin, bell pepper, beetroot, kale, Garlic etc.
EDUCATION
NUTRITION
Milk & Dairy: Consume Probiotics, fermented milk, products, yogurt, cultured butter milk, acidophilus milk.
Fats & Oils: Consume all pure vegetable oils (including canola), Almonds, chia seeds. Avoid trans fatty acids.
Herbs: Any plain herb or spice, tougher on gut should be stayed away.
GENERAL GUIDELINES
• Reduce the use of high fat food or fried items • use milk instead of water to meet the need of fluid • avoid canned food or preserved food with sodium • Avoid tobacco products Decrease consumption of:
Alcohol• Spices, particularly red and black peppers when inflamed • include iron rich food items in the diet .
EXCHANGE CALCULATIONS AND MEAL PLANNING ACCORDING TO NUTRIENT DRUG INTERACTIONS

Milk (Low Fat) 2 24 16 10 240
Milk (Reduced Fat) 0 0
Starch 0 0 0 0 0
Starchy vegetable 5 25 10 125
Fruits 3 45 180
Total 94 28.5
Remaining CHO 8
Total
29

Plant based proteins 0 0 0 0 0
Total 216 86 30 1480
Remaining fats 7
Fats 6 30 270
Drug Names Drug Effect Nutrition Care and caution
INJ. Omeprazole It is used to treat heartburn and may also used Take drug with 8 oz of fluid and maintain
for the treatment of gastric ulcer , GERD , hydration . limit the use of greasy and deep
when there is too much acid in the stomach . fried foods.
TABLE 3.15: DIET PLAN OF PULMONOLOGY WARDS DETAILED CASE
Diet Plan
Pre-Breakfast  Chia seeds + water
(7:00 -7:30) am  1tbsp
 1cup  Oat meal
Breakfast  1tbsp  Granola (topping)
(8:00 – 9:00)am  2  Egg whites
 1 cup  milk
Mid-Morning Snacks  1cup  Apple juice (without peel)
(11:00 – 12:00) am
30
 1cup  Boiled Rice(cooked)

Lunch
 1/2 cup  Baked pumpkin
(1:30 – 2:30)pm  1 oz  Steamed chicken
Evening Snacks  1cup  Lentils soup
(4:00 – 5:00)pm
 1(12 inch)  Chapatti
Dinner
 1 ounce  Fish (cooked)
(7:30 -8:30)pm  1 cup  Salad( cabbage, onion, cucumber, tomato)
Before Bed  2 small size  Peaches
(10:30 -11:00)pm
Note: Take drug with 8 oz of fluid and maintain adequate hydration. Limit caffeine intake.
TABLE 3.16: MEDICAL WARD INDEX
PATIENT DATA ( MEDICAL I & II)

1 Name: Spleenomegaly / Carbohydrates, Height: 5̍ 3 Balanced diet along • Balanced diet : Includes mashed potatoes
Surraiya Underweight, proteins , and fats Weight: 41kg with modified with gravy, yogurt with no fruit added,
Age: 40 years Low protein are added in the diet, BMI: 16 kg/m2 protein and fiber pudding, soups pureed smooth, pureed
Gender: intake , according to (underweight) rich foods fruits and vegetables, pureed
meat/poultry/fish, sauces/gravies, and
Female Dehydration AMDR, IBW: 52 kg Carbohydrate: 189g
pureed desserts without nuts, seeds, or
Fluids : 1.7 liter Goal wt.: 56 kg Protein: 75g coconut.
fluids are added Frame size: 11.4 Fat: 50g •Protein rich foods : eggs , meat , poultry ,
(small) Calories : 1500 kcal nuts and seeds .
31
•Fluids: 1.7 litres of fluids are added in the

diet from pulpy fruits and soups.
2 Name: Abdul Internal Add iron and fiber Height: 5̍4 Calorie controlled • Avoid over eating and to maintain
Majeed Haemorhoids/ rich foods . Weight: 90kg diet provided with normal BMI and was guided on iron
Age: 40years Lower Hb level Managed the correct BMI: 34kg/m2 iron rich foods and rich foods (apricot,peach,kale
Gender: Male Iron deficiency AMDR (overweight) vitamin C canteloup,spinach potato,carrot),
anemia , Fluids are added in IBW: 62kg supplements • Calorie Dense foods (egg, sweet
malnutrition the diet up to 2 liters Goal wt.: 60 Carbohydrate: 230g potato, lentils, beans, whole
(overweight) in the daily routine Frame size: 9 Protein: 92g grains,tortilla,porridge)
intake. (Large) Fat: 61g • iron and fiber rich foods : green leafy
Calories : 1840kcal veg ( spinach , cucumber,broccoli) ,
fruits , nuts and seeds.
3 Name: Diabetes (type2) , Remove excessive Height: 5̍ 4 Consistent carbs diet •iron rich food: green leafy
Ahmad CLD , Low iron calories, Iron rich Weight: 80kg along with modified vegetable , iron supplements if
Age: 55years intake , foods are added ,zinc BMI: 30 kg/m2 fat , iron rich food needed.
Gender: male Malnourished containing fruits are (Overweight) item • Consistent carbohydrate: intake
(overweight ) , added in the diet IBW: 61kg Carbohydrate: 199g, (200g).The patient was also educated
Excessive calorie Goal wt.: 55 Protein: 79g, on taking at least 1.7 liter fluid from
intake Frame size: 9 Fat: 54g, plain water, soups and fruits.
(large) Calories : 1600kcal • Weight management: do exercise
as tolerated
Eat small frequent meals.
4 Name: Razia Pangastritis / Low iodine food Height: 5̍ 3 Anti-inflammatory Anti inflammatory food: green tea ,
32
Bibi hyperthyroidism, should be added , Weight: 42kg diet along with low olives , green leafy vegetable ,
Age: 57years inadequate calorie increase calories BMI: 17 kg/m2 iodine food salmon , fish .
Gender: intake , intake , Fluid intake (underweight) Carbohydrate: 166g, Low iodine food : fresh meat ,
female underweight up to 1.7 liter is IBW: 50 kg Protein: 83g, cereals , homemade breads and fresh
(malnourished) recommended. Goal wt.: 48kg Fat: 37g, herbs and spices .
Dehydration, (1ml/kcal) Frame size: Calories : 1350kcal
9.7(Medium)
5 Name: Areej CKD / Iron rich foods are Height: 5̍ 2 Dash diet along with •iron rich food: green leafy
Junaid Dehydration , added , iclude Weight: 45kg modified protein and vegetable , iron supplements if
Age: 68years. constipation , micronutrient rich BMI: 18.6 kg/m2 iron rich foods needed.
Gender: anemia , food, Nutrient rich (Normal) Carbohydrate: 210g Plant Based proteins: Beans cooked:
female Inadequate foods IBW: 50 kg Protein: 57g black, garbanzo, kidney, lentils, peas,
Nutrient intake Vitamin C: 80 mg Goal wt.: 49 Fat: 51g Bacon” strips, soybased and include
Folate: 400mcg/d Frame size: 11.4 Calories : 1530kcal Nutrient dense foods
(small)
TABLE 3.17: BIOCHEMICAL REPORTS PULMONOLOGY WARD
BIOCHEMICAL DATA (MEDICAL UNIT I and II)

No. Test
Result
1 Areej Hb 7.3 ↓ female, 12-16.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
FBGL 80 ↓ female; <140mg/dl ↑ levels indicate one of the organ or muscles containing the enzyme could be
damaged
2 Abdul Hb 9.8 ↓ male, 12-15.5 g/dL Less than 140mg/dl fasting blood glucose level shows patient is not diabetic.
majeed
33
Alb 3.3 ↓ male, 3.4 to 5.4 g/dL If you have a lower albumin level, you may have malnutrition. It can also
mean that you have liver disease, kidney disease, or an inflammatory disease.
3 Razia bibi Hb 9.1 ↓ female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
SGPT 21 ↓ female; <35IU/l low levels typically indicate a healthy liver, while high levels suggest liver
damage
4 Ahmad Hb 9.8 ↓ male, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
RBGL 580↑ male , ≤ 236 The condition is most often linked with diabetes.
FBGL 340↑ 99 mg/dL or lower Higher ranges could indicate pre-diabetes or diabetes
5 Surraiya Hb 6.1 ↓ Female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
Alb 3.2 ↓ Female, 3.4 to 5.4 g/dL If you have a lower albumin level, you may have malnutrition. It can also
mean that you have liver disease, kidney disease, or an inflammatory disease.
RBGL 78↓ Female; ≤ 236 The condition is most often linked with diabetes
TABLE 3.18: NUTRIENT DRUG INTERACTIONS OF MEDICAL WARD

Inj. Tanzo Dairy product such s milk, yogurt and cheese
decrease the absorption .
Methicobal (Mecobalamin) Methylcobalamin is used to treat vitamin B12 Interact with arsenic trioxide, chloramphenicol,
(vitamin B12 coenzyme) deficiency. Vitamin B12 is important for the cimetidine, dexlansoprazole, esomeprazole,
brain and nerves, and for the production of red famotidine, lansoprazole, nizatidine.
blood cells. Side effects: Nausea, vomiting, Taking vitamin B-12 with vitamin C might reduce
diarrhea, loss of appetite, headache. the available amount of vitamin B-12 in your body.
To avoid this interaction, take vitamin C two or
MEDICAL WARD MEDICINES
more hours after taking a vitamin B-12

supplement.
Omeprazole Long-term use decreases acid secretion may Monitor iron studies, vitamin B12, magnesium
34
inhibit the absorption of iron and vitamin B12; levels, and bone density with long-term use;
lowers calcium absorption may lead to supplement as needed. Consider alternatives in
osteoporosis. Low Mg may occur. those with a diagnosis of SIBO and/or IBS.
Moxiget (moxifloxacin) Drug may rarely precipitate in renal tubules. Take drug with 8 oz of fluid and maintain adequate
Drug will bind to magnesium, calcium, zinc, hydration. Limit caffeine intake. Take at least 4
and iron, forming an insoluble, unabsorbable hours before or 8 hours after antacids, Mg, Ca, Fe,
complex. May cause Clostridium difficile. Zn supplements or multivitamin with minerals.
Tonoflex Drug may cause hepatotoxicity at high dose. Maximum safe adult dose is 3 g/day Avoid alcohol
(Non-narcotic Analgesics) Chronic alcohol ingestion increases risk of or limit to 2 drinks/day.
hepatotoxicity.
Aspirin Drug may cause GI irritation and bleeding; Incorporate foods high in vitamin C and folate
decrease systemic levels of iron, folic acid, Monitor electrolytes and hemoglobin to determine
sodium, and potassium with high dose long- need for potassium or iron supplements. Avoid
term use. Drug may decrease uptake of vitamin alcohol consumption.
C and increase urinary loss.
Tablet Extor Take medicine by mouth with or without food
Take medicine with full glass of water
TABLE 3.19: DETAILED CASE OF MEDICAL WARD
S.N 03 NUTRITIONAL ASSESSMENT (MEDICINE WARD)
HEIGHT (FEET’ 5’2’’ Hb (g/dL) 11 low Current Diagnosis Pangastritis / hyperthyroidism
INCHES”)
ABW (KG) 42 BU (mg/dL) 23 Normal Previous Med History Fever , abdominal pain
UBW (KG) 60 S. Creatinine (mg/dL) 1.1 Normal Family History Diabetes (-),tuberculosis(+)
NAME OF PATIENT
%UBW 110% Bilirubin T. (mg/dL) - - Social History Socioeconomic Geographical Occupation

status location
(23-05-2023)
IBW (KG) 50 SGPT (u/L) 41 Normal Middle class Urban Job (husband )
Razia bibi
(DATE)
%IBW 110% SGOT (u/L) 24 High Physical Examination Anorexia, inappropriate food choices
% Weight Change 10% ADA 137 High Dietary Data Status
Wrist Circ. (cm) 13 MCV 84 Normal Energy Intake (Kcal) 560 Low
Goal Weight (kg/M) 45 MCH 27 Normal CHO Intake (g) 80 57 % High
BMI 17 Underweight
Potassium (mmol/L) 3.7 Normal Protein Intake (g) 24 17 % Low
kg/m2 Na (mmol/L) 145 Normal Fats Intake (g) 18 28 % Low
Frame Size 9.7 Small Clot Formation - - Saturated Fats (g) - -
cm
35
Platelets 577 high Unsaturated Fats (g) - -

Nutrition Diagnosis Diet Order Anti inflammatory diet along with low iodine food item Medical Nutrition Therapy Method used
Nutrition Intervention
Inadequate calorie intake Add calorie dense food items like cereals , broth, wheat , whole grains Energy (Kcal) 1350 HBE
Inappropriate food choices Always choose calorie dense and low sodium foods, with soft consistency and mildly seasoned. Carbohydrates (%) 50 AMDR
Low micronutrient intake Add micronutrient rich foods like fruit and vegetables Proteins (%) 25 AMDR
Fats (%) 25 AMDR
PES STATEMENT Malnourished (underweight) related to less intake of calorie dense food as evidence by dietary intake

Bread & Cereals: Consume Whole wheat Flour, legumes, Rice Boiled, porridge & oatmeal.
Meat & Proteins: Consumes Chick peas, legumes, egg, chicken, use animal protein sources in controlled portions.
Fruits: Consume Apricot, Apple, Avocado, Banana, Grapefruit, Guava, and dates in moderate quantity.
EDUCATION
NUTRITION
Milk & Dairy: Consume Probiotics, reduced fat mil and yogurt.
GENERAL GUIDELINES
Avoid red chili, table salt, Garlic salt.
Cleanliness and hygiene should be maintained.
Skipping of meal should be avoid
Add fiber rich food in the diet
TABLE 3.20: EXCHANGE CALCULATIONS AND MEAL PLANNING ACCORDING TO NUTRIENT DRUG INTERACTIONS
Milk (Low Fat) 0 0 0 0 0
Milk (Reduced Fat) 2 24 16 10 240
Non Starchy vegetables 0 0 0
Starch 0 0 0 0 0
Starchy vegetable 4 20 8 100
Fruits 3 45 180
Total 75 24
Remaining CHO 7
Total
36
Total
Remaining fats 8
Fats 2 10 90
Drugs Drug Effect Nutrition care and caution
Tab Motillium If you take too much motillium you may Take drug with 8 oz of fluid and take drug
experience seizure,drowsiness, confusion and before the consumption of meal.
uncontrolled movements
Tonoflex It will not interact with all foods and medications. Take with or without food.
TABLE 3.21: DIET PLAN OF MEDICINE WARD DETAILED CASE
Diet Plan
Pre-Breakfast  1tsp  Flaxseeds and water
(7:00 -7:30) am
 1  Egg + chicken sandwich
Breakfast  1oz  Chicken
(8:00 – 9:00)am  1  Egg
 1cup  milk
Mid-Morning Snacks  1cup  Yogurt with berries
(11:00 – 12:00) am
 1(12inch)  Chapatti (whole wheat)
Lunch
 ½ cup  Daal mixed( channa,Masoor)
37
(1:30 – 2:30)pm
 Salad(cabbage, onion, cucumber, tomato)
Evening Snacks  1 Whole wheat cracker
(4:00 – 5:00)pm
 1(12inch)  Chapatti (whole wheat)
Dinner
 1cup  Vegetable (round gourd)
(7:30 -8:30)pm
 Plain water
Before Bed  1 ounce  Boiled chicken (homemade)
(10:30 -11:00)pm
Note: take medicines after four hours of eating. Avoid taking methotrexate with caffeine and calcium supplements.
TABLE 3.22: CORONARY WARD INDEX
PATIENT DATA ( CORONARY CARE UNIT)

1 Name: Interior Wall Mediterranean diet Height: 5̍ 3 Consistent Low GI foods: GI GL
Zubaida Bibi myocardial Fluids: 2.1 liter Weight: 76kg carbohydrate meal Carrots 47 3
Age: 40 years infarction, Low Glycemic BMI: 30kg/m2 plan along with Peas green 48 3
Gender: Diabetes type 1 index foods (obese class I) Mediterranean diet Grainy bread 45 6
female Dehydration IBW: 50kg Carbohydrate: Milk Reduced Fat 27 3
Inconsistent Goal wt.: 70 197g, Yogurt 33 10
carbohydrate Frame size: Protein: 81g, cherries 22 3
intake 10.46 (Medium) Fat: 56g,
38
Apricot 31 9
Calories : 1800kcal • Fluids: plain water, low GI fruits, and
lentil soups.
Carbohydrate counting and fat
modification (avoid trans-fat and use
unsaturated fat).
2 Name: Syed Ischemic Heart 200 calories are Height: 5̍ 6 ̎ Dash diet along • Calorie dense foods
Toheed Disease, added in meal plan Weight: 68kg with calorie dense Potatoes, brown rice, whole grain pasta,
Age: 58years Hypertension / Plant based Proteins BMI: 24 kg/m2 and micronutrient whole grains, whole grain breads.
Gender: Male micronutrient are recommended. IBW: 60kg rich food • Plant Based proteins: Beans cooked:
deficiency / Monitor the intake of black, garbanzo, kidney, lima,, lentils,
Goal wt.: 54kg Carbohydrate: 210g
inadequate calorie micronutrient in the peas, Bacon” strips, soybased
Frame size: Protein: 96g
intake diet • Arginine sources: Legumes (soybeans,
Arginine: 400-6000g 10.4cm (small) Fat: 50g chickpeas). Whole grains (brown rice,
Mg: 100-500mg Calories : 1680 kcal oats)
• Mg sources: Whole grains and dark-
green, leafy vegetables
ssssss
3 Name: Severe LV Systolic Add fluid rich food in Height: 5̍ 6 Dash diet along with
Latifan Bibi dysfunctiom / the diet Weight: 70kg modidfied protein • Fruits such as strawberries,
Age: 60years Inadequate Nutrient Nutrient dense foods BMI: 24.9 and nutrient dense blueberries, cherries, and oranges.
Intake/ dehydration are added in the diet Fluid: 2 liter fluid recommended
Gender: kg/m(Normal) foods
Fluid : 2liter according to the age
female IBW: 59kg Carbohydrate: 166g, Nutrient dense foods : egg , spinach,
Goal wt.: 55 Protein: 89g, salmon, avocado,whole grains, skinless
Frame size: 10 Fat: 34g, poultry
(Medium) Calories : 1333kcal
4 Name: Iram Infectious Add low sodium Height: 5̍ 3 ̎ Sodium restricted • Low sodium Foods (fresh fruits, like
Bibi endocarditis / foods in the diet Weight: 39kg diet along with high apples, oranges, or bananas.
Age: 18years. iron deficiency Add iron rich foods in BMI: 15 kg/m2 protein and iron rich Any fresh vegetables, like spinach,
39
Gender: Anemia / the diet (underweight) food items carrots, or broccoli. Frozen
inadequate protein Add 200 calories in
female IBW: 52kg Carbohydrate: 182g, vegetables without added butter or
intake the diet plan
malnourished Iron : 43mg /d
Goal wt.: 45kg Protein: 98g, sauce.
(underweight ) Na: 1500mg Frame size: Fat: 37g, • Iron rich foods: nuts dried fruit.
10cm(Large) Calories : 1460kcal Whole meal pasta and bread.
Iron-fortified bread and breakfast
cereal. Legumes (mixed beans, baked
beans, lentils, chickpeas)
5 Name: Non ST elevation Height: 5̍ 4 Dash diet along with
Parveen Bibi myocardial Add nutrient dense Weight: 56kg modified fats and • Fluids: 1.5l/kcal fluids are
Age: 55years. infection foods in the diet BMI: 21.1 kg/m2 iron rich food items recommended
Gender: (NSTEMI)/ Add 1.5 l/kcal of (Normal) Carbohydrate: 184g • Nutrient-dense foods contain vitamins,
Anemia fluids in the diet minerals, complex carbohydrates, lean
female IBW: 60kg Protein: 92g
Inadequate Nutrient Iron :43mg/d protein, and healthy fats.
intake
Goal wt.: 58kg Fat: 41g
• Iron rich foods: nuts dried fruit.
Dehydration Frame size: 10.4 Calories : 1480kcal
Whole meal pasta and bread.
(medium)
Iron-fortified bread and breakfast
cereal.
TABLE 3.23: BIOCHEMICAL REPORTS OF CORONARY WARD
BIOCHEMICAL DATA (CORONARY CARE UNIT)

No. Test
Result
1 Zubaida Hb 11.8 ↓ Female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
BiBi failure, or renal disease or who are taking certain drugs
RBGL 149 ↓ Female; ≤ 236 Lower random blood glucose levels indicate hypoglycemia.
2 Syed Hb 13.5 ↓ Male , 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
Toheed failure, or renal disease or who are taking certain drugs
Alp 172 ↓ Male , 44 to 147 (IU/L) High levels of ALP may indicate liver disease or certain bone disorders, but
40
an ALP test alone cannot diagnose a condition.

3 Latifan Hb 11↓ female , 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
Bibi failure, or renal disease or who are taking certain drugs
SGPT 21 ↓ female ; <35IU/l low levels typically indicate a healthy liver, while high levels suggest liver
damage
4 Parveen Hb 10.5↓ female , 8 - 45 u/L ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
rashid failure, or renal disease or who are taking certain drugs.
Alp 534↑ female 44 - 147 U/L High levels of ALP may indicate liver disease or certain bone disorders, but
5 Iram SGPT 104↑ Female; <35IU/l High SGPT or SGOT is usually an indication of liver cell injury.
FBGL 10.8 Female; 4.0 – 7.8 The condition is most often linked with diabetes
mmols/L
RBGL 248↑ Female; ≤ 236 The condition is most often linked with diabetes
SGOT 3.2 ↓ Female, 3.4 to 5.4 g/dL High SGPT or SGOT is usually an indication of liver cell injury.
Na 141↑ Female; 135-145 (mEq/L) ↑ Na means there is not enough water in the body rather than too much
salt.
TABLE 3.24: NUTRIENT DRUG INTERACTIONS OF CORONARY WARD

Tab.Blaze Drug may increase urinary loss of magnesium and You can take medicine with or without food .
decrease serum levels of potassium. Avoid taking potassium rich foods before taking
the medicine
Carvedilol Drug may cause wt gain, nausea, vomiting, and Avoid natural licorice and encourage low sodium
diarrhea. May mask symptoms of diabetic diet. Calories if weight loss is the goal. Patients
hyperglycemia. with diabetes should monitor glucose regularly
Metoprolol Drugs may mask signs of or prolong Monitoring of blood glucose levels for
CORONARY WARD MEDICINES
hypoglycemia. Drug may decrease insulin release hypoglycemia or hyperglycemia may be

in response to hyperglycemia. recommended upon initiation of drugs.
Tablet Laprin Drugs may increase serum potassium. Drugs may Caution with high potassium diet or supplements.
cause abdominal pain, constipation, or diarrhea. Avoid salt substitutes. Ensure adequate fluid
41
intake. Avoid natural licorice. Limit Alcohol

Tab. Bisleri Drugs may increase serum potassium. Caution with high-potassium diet or supplements.
Ensure adequate hydration. Avoid natural licorice
and salt substitutes. Cozaar: avoid
grapefruit/related citrus (limes, pomelo, and Seville
oranges).
Diltiazem Drug may cause anorexia, dry mouth, dyspepsia, Avoid natural licorice. Strict adherence to a low
nausea, vomiting, constipation, and diarrhea. sodium diet may antihypertensive effect.
Clonidine Drug commonly causes dizziness, drowsiness, and Avoid alcohol and alcohol products. Drug increase
sedation. sensitivity to alcohol, which may increase sedation
caused by drug alone.
Hydralazine (Apresoline) Drug interferes with pyridoxine (vitamin B6) Maintain a diet high in pyridoxine.
metabolism and may result in pyridoxine Supplementation may be necessary.
deficiency
Tab Sevesto Drug may cause anorexia, nausea, vomiting, taste Avoid grapefruit/related citrus (limes, pomelo, and
changes, or increases in liver enzymes or thyroid Seville oranges) and SJW. Monitor hepatic and
hormones thyroid function. Encourage appealing foods.
TABLE 3.25: DETAILED CASE OF CORONARY CARE UNIT
S.N 04 NUTRITIONAL ASSESSMENT (CORONARY CARE UNIT)
HEIGHT (FEET’ 5’6’’ Hb (g/dL) 16.0 Normal Current Diagnosis Ischemic Heart Disease / Hypertension
INCHES”)
ABW (KG) 68 BU (mg/dL) 31 Normal Previous Med History Nill
UBW (KG) 74 S. Creatinine (mg/dL) 1.0 Normal Family History Diabetes (+), hypertension(+)
NAME OF PATIENT
%UBW 91% Bilirubin 1.2 High Social History Socioeconomic Geographical Occupation
status location
(05-06-20223
Syed Toheed
IBW (KG) 59 SGPT (u/L) 26 Normal Middle class Urban Employ

(DATE)
%IBW 92% SGOT (u/L) 37 Normal Physical Examination Dry , scaling on nails , glossitis , dry lips
% Weight Change 8% TLC 24.7 High Dietary Data Status
Wrist Circ. (cm) 10.5 MCV 82 Normal Energy Intake (Kcal) 875 Low
Goal Weight (kg/M) 55 MCH 28 Normal CHO Intake (g) 106 48 % Normal
BMI 24.9 Normal Left ventricle systolic Ischemic Not normal Protein Intake (g) 42 19 % Normal
kg/m2 dysfunction heart Fats Intake (g) 32 28 % Low
Frame Size 10.6 Small disease Saturated Fats (g) - -
42
cm Unsaturated Fats (g) - -

Nutrition Diagnosis Diet Order Dash diet along with micronutrient rich food items Medical Nutrition Method
Inadequate intake of Add food in the diet like fruit and vegetable , fresh juices, salads which helps to maintain the Energy (Kcal) 1680 HBE
micronutrient deficiency of micronutrient .
Inappropriate food choices Always choose calorie dense and low sodium foods, with soft consistency and mildly seasoned. Carbohydrates (%) 50 AMDR
Low calorie intake Calorie dense food should be added in the diet like eggs , whole grains , broth , cereals , chicken . Proteins (%) 23 AMDR
Constipation Add fibre rich food in diet. Recommended amount of fibre is 28g/d. Magnesium is effective for constipation Fats (%) 27 AMDR
PES STATEMENT Micronutrient deficiency related to less intake of micronutrient rich food as evidence by diet recall

Bread & Cereals: Consume Whole wheat Flour, legumes, Rice Boiled, porridge & oatmeal.
Meat & Proteins: Consumes Chick peas, legumes, egg, chicken, use animal protein sources in controlled portions.
Fruits: Consume Apricot, Apple, Avocado, Banana, Grapefruit, Guava, and dates in moderate quantity.
EDUCATION
NUTRITION
Milk & Dairy: Consume Probiotics, reduced fat mil and yogurt...
GENERAL GUIDELINES
DASH dietary pattern Mediterranean diet pattern • Weight reduction if needed • Increase dietary fiber to 25–30 g/day or more • Add ω-3 fats from food sources • Add fruits
and vegetables
TABLE 3.26 : EXCHANGE CALCULATIONS AND MEAL PLANNING ACCORDING TO NUTRIENT DRUG INTERACTIONS
43
Milk (Low Fat)
Starch 0 0 0 0 0
Fruits 3 45 180
Total 121 31
Remaining CHO 6
Bread & cereals 6 90 6 480
44

Total 211 90 15 1350
Remaining fats 6
Fats 5 25 225
Tab Sevesto Very serious reaction this drug is rare . cough , Incorporate foods high in vitamin C . food
dizziness or light headache may occur decreases the absorption of drug do not take it
with food
Morphine Narcotics can be highly addictive and may cause Monitor respiratory function and bowel
severe dose-related sedation, respiratory function . Do not crush or chew sustained-
depression, dry mouth, and constipation. Drugs release.
cause slowing of digestion.
TABLE 3.28: SURGERY WARD INDEX
PATIENT DATA (SURGERY)

1 Name: Alina Cervical Add nutrient dense Height: 5̍1 Nutrient dense diet • Nutrient dense foods such as tortilla,
Age:16years lymphodenopathy foods in diet Weight: 42kg along with anti meat, beef, fish, eggs, chicken, corn oat
Gender: (Post-Operative) Add micro nutrient BMI: 15.3 kg/m2 inflammatory and meal, rice.
Female imbalance of rich fruits and (underweight) iron rich foods • iron rich foods: Darkgreen leafy
macro-nutrients/ vegetables in diet IBW: 54kg Carbohydrate: 191g vegetables such as spinach , kale ,
Anemia / Iron : 40 mg/d Goal wt.: 50kg Protein: 76g broccoli,cabbage , eggs , nuts
Malnourished Calcium: 1200mg/d Frame size:10.1 Fat: 50g
45
(underweight ) Vit. C: 75 mg/d Calories : 1530kcal
2 Name: Right breast CA Remove excess Height: 5̍5 Consistent carbs

Bushra Bibi (pre operate)/ calories and add Weight: 80kg diet along with Antioxidant rich foods:Broccoli,
Age: 54years Diabetic / goof food choices BMI: 29 kg/m2 modified fat and spinach , potatoes, carrot, avocado,
Gender: Malnourished Add micronutrient (overweight) antioxidant rich pumpkin.
Female (overweight ) / rich foods. IBW: 57kg food items • Vitamin C rich foods are Citrus
Micronutrient Vit C : 90 mg/d Goal wt.: 65kg Carbohydrate: 198g (oranges, kiwi, lemon, and grapefruit)
deficient / low Vit. E : 15mg/d Frame size: Protein: 91g Bell peppers, Strawberries and
protein intake 9.1cm(Large) Fat: 47g Tomatoes.
Calories : 1591kcal
3 Name: Hajra Laparotomy Progressive Diet Height: 5̍ 2 ̎ Clear liquid Diet •Add Fluids in diet up to 2 litres
Fahad and ileostomy ( 1-2 days “clear liquid” Weight: 32kg Carbohydrate: 259g, when GIT ables to function properly
Age: 25years. post- Full liquid diet BMI: 13.0 kg/m2 Protein: 30g, Add Nutrient dense foods in clear
Gender: operative)/ Full liquid blenderized (underweight) Fat: 13g, liquid •diet( Beef broth, grape juice,
Female low hydration diet. IBW: 64kg Calories : 770kcal flavored gelatin, coffee,, tea, chicken
status Goal wt.: 40kg broth)
Malnutrition Frame size:
12cm (small)
4 Name:Sahrish Cholelithiasis Add nutrient dense Height: 5̍ Nutrient dense diet • Fiber Sources: lentils , raspberry ,
Age: 30years. (post - food in the diet Weight: 54kg along with healthy chia seeds, basil seed drink,oatmeal,
Gender: operative)/ low Choose Fiber rich BMI: 23.2kg/m2 fats and fiber rich porridge .
Female fiber intake / food (normal) foods
46
• Calcium +iron Avoid consuming

Anemia Iron : 40mg/d IBW: 45 kg Carbohydrate: 198g, calcium with iron rich foods.
Inadequate Fiber: 25 mg Goal wt.: 47kg Protein: 91g, • Iron rich foods: nuts dried fruit.
nutrient intake Fluid : 1.6 liter Frame size: Fat: 47g, Whole meal pasta and bread.
9.2cm(Large) Calories : 1585kcal Iron-fortified bread and breakfast
cereal. Legumes (mixed beans, baked
beans, lentils, chickpeas)
5 Name: Sana Intestinal Add nutrient rich Height: 5̍ 1 Bland Diet • Nutrient dense foods such as
Shabbir obstruction/ foods Weight: 45kg Carbohydrate: 163g tortilla, meat, beef, fish, eggs, chicken,
Age: 19years. Dehydration Add fluids rich foods BMI: 20 kg/m2 Protein: 81g corn oat meal, rice.
Gender: female Add fibre rich foods (Normal) Fat: 36g • Fibre rich foods (Dates, oats, Plum,
Vit. B12: 2.4mcg IBW: 53kg Calories: 1400kcal Almonds, Apple, cucumber, potato,
Goal wt.: 50kg Peas, Carrot).
Frame size: • Fluids: Watermelon, Strawberries,
11.25cm Cantaloupe, Peaches, Milk
(medium) • B12 rich foods: Beef, liver, and
chicken.
Fish and shellfish such as trout,
salmon, tuna fish.
TABLE 3.29 : BIOCHEMICAL DATA OF SURGERY WARD.
BIOCHEMICAL DATA (SURGERY)

No. Test
Result
1 Alina Hb 10.2 ↓ Female, 12-16.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
SGOT 74 ↑ Female, 8-45 units/l If the liver is injured or damaged, the liver cells spill these enzymes into the blood,
which causes the SGOT and SGPT enzyme blood levels to rise.
SGPT 110 ↑ Female; <140mg/dl If the liver is injured or damaged, the liver cells spill these enzymes into the blood,
which causes the SGOT and SGPT enzyme blood levels to rise.
2 Bushra RBGL 111 ↓ Female , ≤ 236 Lower random blood glucose level indicates hypoglycemia
47
Bibi Alb 3.7 ↓ Female, 3.4 to 5.4 g/dL If you have a lower albumin level, you may have malnutrition. It can also mean that
you have liver disease, kidney disease, or an inflammatory disease.
3 Hajra RBGL 135 ↓ Female , ≤ 236 Lower random blood glucose level indicates hypoglycemia
fahad
4 Sehrish Hb 8.9 ↓ Female , 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
MCV 57 ↓ Female , MCV: 80 to 100 Common conditions resulting in a hypochromic microcytic anemia (low MCV and
femtoliter MCH) include thalassemia and iron deficiency
MCH 21 ↓ Female , MCH: 27 to 31 Common conditions resulting in a hypochromic microcytic anemia (low MCV and
picograms/cell. MCH) include iron deficiency
5 Sana Hb 9.1 ↓ Female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
shabbir failure, or renal disease or who are taking certain drugs
MCV 70 ↓ Female, MCV: 80 to 100 Common conditions resulting in a hypochromic microcytic anemia (low MCV and
femtoliter MCH) include iron deficient and thalasesemia
MCH 24 ↓ Female, MCH: 27 to 31 Common conditions resulting in a hypochromic microcytic anemia (low MCV and
picograms/cell. MCH) include thalassemia and iron of deficiency
TABLE 3.30: NUTRIENT DRUG INTERACTIONS OF SURGERY WARD MEDICINES

Metronidazole (Flagyl) May cause anorexia, GI distress, stomatitis, and Take with food to lower GI distress. Eat small,
metallic taste in mouth. May cause disulfiramlike frequent, appealing meals to decrease anorexia.
reaction when ingested with alcohol. Often used to Avoid all alcohol during use and for 3 days after
treat Clostridium difficile. discontinuation. Probiotic is advised.
Tab Toradol Drugs may cause significant sedation. Avoid concurrent ingestion of alcohol, which will
Benzodiazepine drugs are highly addictive. produce CNS depression. Avoid taking drug
SURGERY WARD MEDICINES
without food
Tab Augmentum May cause weight loss, increased thirst, Take oral forms with food or 8oz water to decrease
esophagitis, nausea, vomiting, cramps, flatulence, esophageal irritation. Replace fluids & electrolytes
bloating, or diarrhea. for diarrhea. Probiotic is advised.
48
Nitrofurantoin Peripheral neuropathy, muscle weakness and Drug should be taken with adequate calories,
(Macrobid) wasting may occur with preexisting anemia, protein, and vitamin B complex. Avoid in G-6-PD
vitamin B deficiency or electrolyte abnormalities. deficiency because of increased risk of hemolytic
May cause Clostridium difficile. anemia. Replace fluids & electrolytes for diarrhea.
Probiotic is advised
Tab Mark - 20 Drug may cause dyspepsia, abdominal pain, GERD, Avoid alcohol and supplements . Chewing can
esophagitis, erosive gastritis, diarrhea, gastric decrease bioavailability by 75%. Take with fo
hemorrhage, or GI ulcer. Alcohol may cause
bleeding.
Non-Steroidal Anti- Standard warning with NSAIDs: GI: increases Take drug with food or milk to decrease risk of GI
Inflammatory Drugs risk of serious GI events (bleeding, ulceration, toxicity. Avoid use in the elderly or in individuals
(NSAIDs) perforation of stomach & intestines) can occur at with severe cardiovascular disease.
• ibuprofen (Motrin) any time during use without warning.
S.N 05 NUTRITIONAL ASSESSMENT (SURGERY WARD)
HEIGHT (FEET’ 5’ Hb (g/dL) 13.2 Normal Current Diagnosis Cholelithiasis( post-surgery)
INCHES”)
ABW (KG) 54 BU (mg/dL) 18 Normal Previous Med History Not significant
UBW (KG) 65 S. Creatinine (mg/dL) 0.6 Normal Family History Diabetes (+), HTN (+)
NAME OF PATIENT
%UBW 88.3% Bilirubin T. (mg/dL) 1.5 High Social History Socioeconomic Geographical Occupation
status location
(21-06-20223
IBW (KG) 58 SGPT (u/L) 27 Normal Middle class Urban Online job
(DATE)
Sehrish
%IBW 100% SGOT (u/L) 23 Normal Physical Examination Dehydration, tongue dry , Nails: Pale mottled poor blanching
% Weight Change -11% Alp 200 Normal Dietary Data Status
Wrist Circ. (cm) 17.5 MCV 82 Normal Energy Intake (Kcal) 1250 Low
Goal Weight (kg/M) 56 MCH 30 Normal CHO Intake (g) 172 55 % Normal
BMI 23.7 Normal Potassium (mmol/L) 4.6 Normal Protein Intake (g) 68 21 % Normal
kg/m2 Na (mmol/L) 139 Normal Fats Intake (g) 39 28 % Normal
Frame Size 9.2 Large Clot Formation - - Saturated Fats (g) - -
cm Platelets - - Unsaturated Fats (g) - -
Nutrition Diagnosis Diet Order Fat Restricted Diet along with Fiber rich foods. Medical Nutrition Method
Dehydration Always choose pulpy fruits like water melon, peach, pear, plum, and their juices. Energy (Kcal) 1590 HBE
49
Inadequate calorie intake Add food in the diet from all food group , choice should be healthy Carbohydrates (%) 50 AMDR
constipation Add 25 grams of fibre per 1000 kcal. Proteins (%) 23 AMDR
Fats (%) 27 AMDR
s Fluids (L) 1.6 L 1mL/Kcal
PES STATEMENT Constipation is related to less intake of fiber rich foods as evidenced by usual day’s intake assessment (25g/d fibre).
Bread & Cereals: Plain nonfat cereals, spaghetti, Noodles, Rice, macaroni, plain whole grain or enriched breads, air popped popcorn, bagel and muffin.
Fruits: Consume Apricot, Apple, Avocado, Banana, Grapefruit, Guava, and dates.
Meat & Proteins: always choose egg whites, lean, meat, Fish, Poultry.
EDUCATION
NUTRITION
Vegetables: Any plainly prepared fresh, broccoli pumpkin, bell pepper, beetroot, kale, Garlic etc.
Milk & Dairy: Skim milk, Butter milk made with skim milk, tea made with skim milk
Fats & Oils: Consume 40g fat from safe choices like vegetable oils (including canola), Almonds, chia seeds. Avoid trans fatty acids.
GENERAL GUIDELINES
Acute Easily digestible foods • Low-fat diet • 6 small meals • Adequate protein intake • Increased calories
Chronic : • Provide oral diet as in acute phase • TF can be used when oral diet is inadequate or as a treatment to reduce pain • Supplement pancreatic enzymes • Supplement
fat-soluble vitamins and vitamin B12
TABLE 3.31DETAILED CASE OF SURGERY WARD INDEX

TABLE 3.32: EXCHANGE CALCULATIONS AND MEAL PLANNING ACCORDING TO NUTRIENT DRUG INTERACTIONS.

Milk (Low Fat) 2 24 18 3 200
Starch 0 0 0 0 0
Fruits 3 45 180
Total 109 31
Remaining CHO 92
Total
50

Total 241 103 17 1
Remaining fats 2
Fats 2 10 90
Injection Risek Doesn’t interact with food Take with food to reduce hepatotoxicity.
Tab Tonoflax It may upset stomach , nausea , drowsiness Avoid alcohol. Take medicine with fiber rich foods
TABLE 3.33 : DIET PLAN OF SURGERY WARD DETAILED CASE
Diet Plan
Pre-Breakfast  1tbsp  Pumpkin seeds
(7:00 -7:30) am
Breakfast  1cup  Cereal with mixed nuts
 1 egg  Boiled
(8:00 – 9:00)am
 1cup  Milk
Mid-Morning Snacks  1cup  Hummus + veggies
(11:00 – 12:00) am
Lunch  1cup  Rice and seasonal vegetable
51
 2/3 cup  Yogurt (low fat)

(1:30 – 2:30)pm
 Salad(cabbage, onion, cucumber, tomato)
Evening Snacks  1 cup  Fruit salad ( peach , apple)
(4:00 – 5:00)pm
Dinner  1 (12inch)  chapatti
(7:30 -8:30)pm  1 cup  Baked beans
Before Bed  1 cup  Milk
(10:30 -11:00)pm
Note: Take drug with 8 oz of fluid and maintain adequate hydration. Limit caffeine intake. Take at least 4 hours before or 8 hours
after antacids, Mg, Ca, Fe, Zn supplements or multivitamin with minerals.
TABLE 3.34: GYNECOLOGY WARD INDEX
PATIENT DATA (GYNECOLOGY)

No Name Nutritional Nutrition Assessment
. (Age) Diagnosis Intervention
1 Name: Amina Gravida 3 Add calorie and Height: 5feet Nutrient-Dense • Nutrient-dense foods (red meat, fish,
Attique Para 2 Nutrient dense foods Weight:85 kg Diet along with and poultry) and iron-rich foods (peach
Age: 28years Abortion 0 to the diet Plan of BMI: 37 kg/m2 antioxidant and pear, Beetroot juice and spinach. Patient
Post-Operative Patient (Normal) iron rich food was also guided on fluid requirement
1ml/kcal.
36th Week with Fluids : 1ml/kcal IBW:63 kg Carbohydrates :
anemia / Iron: 9mg/d Frame size: • Iron rich foods
269g
Imbalance of Vit. C:120mg/d 9.5cm (a)Heme sources is found only
Protein : 108g
Nutrient Intake / Zinc: 12mg/d (medium) in animal flesh like meat, poultry, and
52
Fats: 72g
Dehydration Folic acid:600mcg/d seafood.
Calories: 2100 kcal
(b) Non Heme iron sources Fortified
breakfast cereals.Beans.Dark chocolate
(at least 45%) Lentils.Spinach.Potato
with skin.Nuts seeds. Enriched rice or
bread
2 Name: Areeba Gravida 2 Low GI foods Height: 5.4 feet Consistent Low GI Foods
iftikhar Para 1 Weight:45 kg carbohydrate meal Food items GI GL
Age: 25years Abortion 0 Iron: 27mg/d BMI: 17.12kg/m2 plan along with
Vit. C:85mg/d cherries 47 3
Pre-Operative (underweight) anti-inflammatory
36th Week Zinc: 11mg/d IBW:55 kg foods Peas green 48 3
Gestational Vit. D: 600 IU/d Goal wt.: 52 kg Carbohydrate: Grainy bread 45 6
Diabetes mellitus Folic acid:600mcg/d Frame size: 244g Milk Reduced Fat 27 3
Imbalance of Avoid empty calories 11.25cm Protein: 87g
Yogurt 33 10
Nutrient Intake (small) Fat: 72g
Calories: 2055kcal • Fluids: plain water, low GI fruits, and
lentil soups.
Carbohydrate counting and fat
modification (avoid trans-fat and use
unsaturated fat).
3 Name: Nouroz Gravida 2 Add calorie dense Height: 4.5 feet Sodium restricted • Calorie-dens foods are porridge, chapatti,
Bukhari Para 1 foods Weight:58 kg diet along with and oatmeal. Meat beef, chicken turkey,
Age: 22years Abortion: 0 In diet BMI: 21.64kg/m2 micronutrient rich Lamb, etc.
Gender: Female 36th week with Iron: 27mg/d (Normal) food • Avoid adding to much salt while cooking
Vit. C:85mg/d the food
high blood IBW:50 kg Carbohydrates :
Zinc: 11mg/d Cook food to the proper temperature.
pressure/ Frame size: 190g
Vit. D: 600 IU/d • Add adequate amount of fluids to the
Inadequate caloric 9.25cm Protein: 75g diet.
intake / Folic acid:600mcg/d (large) Fats: 56g
micronutrient Calories: 1530kcal
deficiency
4 Name: Nusrat Fibroid uterus, Add low GI foods, Height: 5feet 2 Mediterranean • Calorie dense foods: egg, chicken,
Age: 45 years diabetic and Add at least 2 litres inches diet along with turkey, beef, mutton, porridge, chapatti,
Gender: Female hypertensive / iron of fluids in diet Weight:57 kg consistent whole wheat bread, rice and cereals.
• Olestra cause GI distress. So, limit its
deficiency anemia, Iron: 27mg/d BMI: 23kg/m2 carbohydrate meal use or avoid it.
inadequate calorie Vit. C:85mg/d (Normal) plan and iron rich • Iron rich foods
53
intake, inadequate Zinc: 11mg/d IBW:50kg foods (a)Heme sources is found only in animal
macronutrient Vit. D: 600 IU/d Frame size: 9.8 Carbohydrates : flesh like meat, poultry, and seafood.
intake Folic acid:600mcg/d (medium ) 193g (b) Non Heme iron sources Fortified
breakfast cereals.Beans.Dark chocolate (at
Protein: 77g least 45%) Lentils.Spinach.Potato with
Fats: 52g skin.Nuts seeds. Enriched rice or bread
Calories: 1546kcal • Vitamin C Sources: Citrus (oranges,
lemon, grapefruit, peach, pear and plum)
• Calcium +iron Avoid consuming
calcium with iron rich foods.
Supplements(ostebone,Vitrum,
SeaCal)
5 Name: Kashaf Gravida 2 Add calorie and Height: 5feet 5 Nutrient-Dense Note: Avoid taking iron and calcium
Zuhair Para 1 Nutrient dense foods inches Diet along with supplements together.
Age: 28yrs Abortion 0 to the diet Plan of Weight:78 kg modified protein
Reason: Calcium hinders iron absorption.
Female Pre-operative Patient, Fluids : BMI: 28 kg/m2 rich foods
36th Week with 1ml/kcal IBW:75kg Carbohydrate: • Nutrient dense foods (red meat, fish,
decrease fetal Iron: 9mg/d Goal wt.: 75 kg 288g and poultry) and iron rich foods (peach
motility/ Vit. C:120mg/d Frame size: 10 Protein: 115g pear, Beetroot juice and spinach. Patient
Inadequate Zinc: 12mg/d (small) Fat: 76g was also guided on fluid requirement
calorie intake, 1ml/kcal.
Vit. D: 600 IU/d Calories :2100kcal
inadequate Folic acid:600mcg/d
protein intake Additional calories
for lactation:
452kcal
TABLE 3.35 : BIOCHEMICAL TEST REPORTS OF GYNECOLOGY WARD INDEX
BIOCHEMICAL DATA (Gynecology)

No. Test
Result
1 Kashaf Hb 10.8 ↓ Female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
zuhair failure, or renal disease or who are taking certain drugs
54
RBGL 139 ↓ Female; ≤ 236 Lower random blood glucose levels indicate hypoglycemia.
2 Nouroz Hb 11.7 ↓ Female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
bukhari failure, or renal disease or who are taking certain drugs
Alp 3.3 ↓ Female, 44 to 147 (IU/L) High levels of ALP may indicate liver disease or certain bone disorders, but
3 Nusrat Hb 5↓ Female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
MCH 55 ↓ MCH: 27 to 31 Common conditions resulting in a hypochromic microcytic anemia (low MCV
picograms/cell and MCH) include thalassemia and iron deficiency
4 Amna Hb 9.5↑ Female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
attique failure, or renal disease or who are taking certain drugs
Alp 534↑ Female 44 - 147 U/L High levels of ALP may indicate liver disease or certain bone disorders, but
5 Areeba Hb 10.8 ↓ Female, 12-15.5 g/dL ↓ Iron-deficiency anemia, hemorrhage, hemolysis, genetic aberrations, marrow
FBGL 10.8 Female; 4.0 – 7.8 The condition is most often linked with diabetes
mmols/L
RBGL 248↑ Female; ≤ 236 The condition is most often linked with diabetes
Na 160↑ Female; 135-145 (mEq/L) ↑ Na means there is not enough water in the body rather than too much salt.
DrugDrug Effect Nutritional Implications and Cautions
GYNECOLOGY WARD MEDICINES
Flaygyl (metronidazole)
May cause anorexia, GI distress, stomatitis, and Take with food to decrease GI distress. Eat small,
(Antiprotozoal/Antibacterial)
metallic taste in mouth. May cause frequent, appealing meals to decrease anorexia.
disulfiramlike reaction when ingested with Avoid all alcohol during use and for 3 days after
alcohol. Often used to treat Clostridium discontinuation. Probiotic is advised.
difficile.
55
It helps to control the blood sugar level . it may Take drug with food or milk to reduce the risk of
Glucophage cause dizziness , diarrhea , increase senstivity of nausea and vomiting
the skin
Augmentin Long-term use may lead to oral candidiasis, Use caution with low-sodium diet or potassium
(amoxicillin )(Amoxil) diarrhea, and epigastric distress. Some products supplements. Augmentin: take with food to lower
contain high amounts of potassium or sodium. GI distress. Replace fluids & electrolytes for
May cause Clostridium difficile. diarrhea. Probiotic is advised.
Velusef (A semisynthetic Food increases bioavailability of tablets and Take with a meal for optimal bioavailability. Take
cepphloceporin antibiotic) suspension. Antacids, Ca, and Mg supplements separately from antacids, Ca, or Mg supplements.
may bioavailability Probiotic may be advised.
TABLE 3.36 : NUTRIENT DRUG INTERACTIONS OF GYNECOLOGY WARD MEDICINES
S.N 06 NUTRITIONAL ASSESSMENT ( GYNECOLOGY WARD)
HEIGHT (FEET’ 5’ Hb (g/dL) 10.8 Low Current Diagnosis G2,P1 36ST week with decrease fetal motility
INCHES”)
ABW (KG) 78 BU (mg/dL) 29 High Previous Med History Not significant
UBW (KG) 64 S. Creatinine (mg/dL) 0.9 Normal Family History Diabetes (-),tuberculosis(-)
NAME OF PATIENT
%UBW 101.3% Bilirubin T. (mg/dL) - - Social History Socioeconomic Geographical Occupation

Kashaf Zuhair
status location
(09-07-2023)
IBW (KG) 75 SGPT (u/L) - - Middle class Urban Homemaker

(DATE)
%IBW 100% SGOT (u/L) - - Physical Examination Dehydration, cracks on lips, pale skin
% Weight Change 11% Alp - - Dietary Data Status
Wrist Circ. (cm) 16 MCV - - Energy Intake (Kcal) 1640 low
Goal Weight (kg/M) 75 MCH - - CHO Intake (g) 151 50 % Normal
BMI 28 Normal Potassium (mmol/L) 4.2 Normal Protein Intake (g) 34 12 % Low
kg/m2 Na (mmol/L) 141 Normal Fats Intake (g) 51 25 % Normal
Frame Size 10cm Small BSR(mg/dL) Saturated Fats (g) - -
Platelets - - Unsaturated Fats (g) - -
Nutrition Diagnosis Diet Order Nutrient dense diet along with modified protein rich foods. Medical Nutrition Method
56

Dehydration Always choose pulpy fruits like water melon, peach, pear, plum, and their juices. Energy (Kcal) 2100 HBE
Inadequate Nutrient intake Add nutrient dense foods to the diet. Carbohydrates (%) 228 AMDR
Low protein intake Add protein rich foods like eggs, poultry, meat , nuts . Proteins (%) 115 AMDR
Fats (%) 76 AMDR
PES STATEMENT Inadequate protein intake related to less intake of protein rich foods as evidence by diet history

Meat & Proteins: lean meat, beef, chicken, lamb, turkey, and medium fat meat.
Fruits: Consume Apricot, Apple, Banana, Grapefruit, Guava, and dates.
Bread & Cereals: Plain nonfat cereals, spaghetti, Noodles, Rice, macaroni, plain whole grain or enriched breads, air popped popcorn, bagel and muffin.
EDUCATION
NUTRITION
Vegetables: Any plainly prepared fresh, broccoli pumpkin, bell pepper, beetroot, kale, Garlic etc.
Fats & Oils: consume fat from safe choices like vegetable oils (including canola), Almonds, chia seeds. Avoid trans fatty acids.
GENERAL GUIDELINES
• Avoid unpasteurized milk. • Diet alone may not be enough supplementations may be required.
• Separate raw meat from ready to eat food when shopping, preparing and storing • Pay attention to food calls, this is not the time to gamble.
food. • Cook foods to proper temperature.
• Wash hands thoroughly with soap and water. • Avoid unpasteurized fruit juices.
TABLE 3.37: DETAILED GYNECOLOGY WARD CASE
TABLE 3.38 : EXCHANGE CALCULATIONS AND MEAL PLANNING ACCORDING TO NUTRIENT DRUG INTERACTIONS

Milk (Low Fat) 2 24 18 4 200
Milk (Reduced Fat) 0 0 0 0
Starch 0 0 0 0 0
Fruits 4 60 240
Total 39
Remaining CHO 7
Total
Remaining proteins
57

Plant-based proteins
Total 216 96 33
Remaining fats 10
Fats 8 40 360
TABLE 3.39: DIET PLAN OF GYNECOLOGY WARD DETAILED CASE
Diet Plan
Pre-Breakfast 4-5  Almond
(7:00 -7:30) am 1cup  Milk
1 cup Milk  Oat meal;
Breakfast 1 banana  (banana, almonds, flax seeds, Milk, Oats)
(8:00 – 9:00)am 1tsp seeds  Plain water
Mid-Morning Snacks 1 full size  Peach
(11:00 – 12:00) am 1/2 cup  Yogurt
58
2(12inch)  Chapatti
Lunch 4 oz meat  Curry( mushroom and carrot , 4oz chicken
(1:30 – 2:30)pm 1cup starchy and non-starchy gravy)
vegetable  Salad(cabbage, onion, cucumber, tomato)
Evening Snacks 1 cup  chickpeasSalad(cabbage, onion, cucumber,
tomato, chickpeas )
(4:00 – 5:00)pm

3 serving  Boiled rice
Dinner 4ounces  Curry (spinach , chicken 4oz.)
(7:30 -8:30)pm ½ cup non starchy vegetables  Salad( cucumber)
1 cup starchy vegetables
Before Bed 1cup  Lentil soup
(10:30 -11:00)pm  (Bean, lentil or split pea)
5 Chapter 4
5.1 Conclusion
The Human Nutrition and Dietetics internship at Gulab Devi Hospital has been an enriching
and transformative experience for aspiring nutritionists and dietitians. Through this 3 months
duration internship, I was able to gain knowledge and skills in the following fields: outpatient
nutrition, coronary care nutrition, pediatric nutrition, cancer nutrition, medical nutrition,
pulmonology nutrition, reproductive nutrition, and oncology nutrition. Moreover, the
internship has fostered a deep appreciation for patient-centered care. Interacting with
patients, understanding their unique needs, and tailoring interventions accordingly
underscored the significance of empathy, communication, and cultural sensitivity in
healthcare interactions
5.2 Internship Outcomes

The following are the learning outcomes of internship;
 Practical Skills: Developed hands-on skills in conducting nutritional assessments and
creating personalized diet plans.
 Patient Interaction: Successfully communicated dietary recommendations to patients,
adapting explanations to individual needs.
 Collaboration: Worked effectively within interdisciplinary healthcare teams, contributing to
comprehensive patient care.
 Research Contribution: Contributed to research projects, gaining insights into the research
process and its impact on healthcare.
 Adaptability: Demonstrated adaptability by handling diverse patient cases and adjusting
strategies accordingly.
 Problem Solving: Developed problem-solving skills by addressing unique patient challenges
and dietary needs.
 Confidence: Gained confidence in applying evidence-based practices to design effective
dietary interventions.
 Professional Growth: Achieved personal growth in terms of communication, ethics, and
understanding patient-centered care.
59
 Contribution to Patient Well-being: Played a role in improving patient outcomes by
providing tailored nutrition plans.
 Enhanced Resumé: Strengthened resumé with practical experience and skills crucial for a
career in nutrition and dietetics.
5.3
ssssssssss
Limitations
 Time Constraints: The duration of my internship was relatively short, which
sometimes made it challenging to engage in in-depth projects or witness the long-
term progress of patients I worked with.
 Cultural Diversity: Working with patients from diverse cultural backgrounds was
enriching, but it also presented challenges in terms of effective communication and
understanding cultural nuances related to dietary habits.
 Limited Research Involvement: While I had the chance to engage in research
projects, the limited time and availability sometimes hindered my ability to contribute
as extensively as I had hoped.
60
Appendix
Name of Intern: Date:
Ward: INPATIENT DATA SHEET Preceptor:
Name: Age(Years): Gender:
Marital status: DOB: Vitals:
Temp(F0):
Doctor In-charge: Admission date:
B/P(mmhg)
Current Diagnosis:
1.
2.
3.
Previous Medical History:
Family History:
Social history:
Living/ housing conditions: , Geographic Location:
_, Occupation: ,
Any other relevant information:
Relevant Drug History:
Anthropometric measurements:
Height (Feet/Inches): _____________ ABW (Kg): _________________UBW (Kg): ____________%UBW (%):_________________
IBW (Kg):_____________________%IBW (%):__________________% Weight Change: __________________________________
Wrist Circumference (Cm):_________Goal Weight: ________BMI:___________________Frame Size:____________________
Biochemical Profile:
Date Test Name Result Date Test Name Result Date Test Name Result
Hb (g/dL) Alp (u/L) FBGL (mg/dL)
BU (mg/dL) Alb (g/dL)
S.Cr (mg/dL) Na (mmol/L)
T.Bil K (mmol/L)
SGPT (u/L) Cl (mmol/L)
SGOT (u/L) RBGL (mg/dL)
Physical Exam Findings:

Hydration Status:
Skin: Lips:
Hairs: Mouth:
Nails: Teeth/gums:
Eyes: Tongue:
GI Function:
Taste:
Smell:
Appetite:
Bowel Frequency:
Diet History
1. How may servings/ week of the foods given below do you consume?
Foods Serving/week Likes (name of food) Dislikes (name of food)

Milk and milk products
- -
Meat and meat substitutes
- -
Vegetables
- -
Fruits
Breads and Cereals
- -
- -
Fruit juices and shakes
- -
Nuts and legumes
- -
2. Do you exercise regularly? No
Yes
If yes, describe the type and duration of exercise. (mins)
3. If elderly, what kind of daily physical activity can you perform independently?
4. Are you taking any form of dietary supplement? Yes No

If yes, then what type of supplement?
5. Do you smoke? Yes No

If yes, how many cigarettes/day do you smoke?
6. Do you consume alcohol? Yes No
If yes, state the quantity of alcohol consumption.
7. Frequency of eating outside home/ready prepared meals
USUAL DAY’S
INTAKE
Energy
Meal of the day/time Food items description Quantity Exchange
Kcal
Breakfast
Mid-morning snack
Lunc
h
Evening snack
Dinne
r
Total energy(Kcals):
Usual day’s Intake Assessment:
Assessment (↑, ↓ or ≈)
Energy(kcal/day) Cholesterol (mg)

CHO(gm) Fiber (gm)
Proteins (gm) Calcium (mg)
Total Fats (gm) Magnesium (mg)
Saturated fats (gm) Potassium (mg)
Unsaturated fats (gm) Sodium (mg)
% CHO Phosphorus (mg)
% Proteins Iron (mg)
% Fats Vitamin C (mg)
Riboflavin (mg) Thiamin (mg)
Vitamin B-12 (µg) Folic Acid(µg)
Nutrition/ Dietary Diagnosis:
1.
2.
3.
Medical Nutrition Therapy:
Calculations Mention formula

Energy & Macronutrients Method used Justificatio
n
Energy (Kcal)
CHO (% or g)
Proteins(% or
g)
Fats (% or g)
Fluid (Liters)
Micronutrients (if any)
Diet Order:
EXCHANGES CALCULATION
Exchange
Carbohydrates Proteins Fats Calories
Food Group s
Milk(Free/Low Fat)
Milk(Reduced Fat)
Milk(Whole)
Vegetables
Fruits
TOTAL
Remaining
Calculation
Carbohydrates
Bread & Cereals
TOTAL
Remaining Proteins Calculation
Proteins(Very Lean)
Proteins(Lean)
Proteins(Medium Fat)
Proteins(High Fat)
TOTAL
Remaining Fats Calculation
Fats
TOTAL
Dietary Instructions:
Foods Recommended Foods Avoided
Bread & Cereals Bread & Cereals
Milk & Dairy Milk & Dairy
Meat & Proteins Meat & Proteins
Vegetables Vegetables
Fruits Fruits
Fats & Oils Fats & Oils
General Guidelines:
WORKSHEET 1: ADIME CHARTING EXERCISE
A: A B C D
Height (Feet/Inches):________ Energy Intake:__________Kcal
Weight (Kg):_______________ CHO

Intake:____________ g
D:
I:
Diet Order:
M&E: Expected Outcomes
Energy Intake:__________Kcal Energy Intake:__________Kcal

CHO Intake:____________ g CHO Intake:____________ g
Protein Intake:__________ g Protein Intake:__________ g
Fats Intake:____________ g Fats Intake:____________ g
Bowel Frequency:___________ (Consistency:___________) Bowel
Frequency:___________(Consistency:__________)
RBGL:___________(mg/dL)
RBGL:___________(mg/dL)
FBGL:___________(mg/dL)
FBGL:___________(mg/dL)
WORKSHEET 2: NUTRITION INTERVENTION
DATE NUTRITION PROBLEM NUTRITION INTERVENTION EXPECTED OUTCOME

WORKSHEET 3: NUTRITION EDUCATION
DATE NUTRITION NUTRITION EDUCATION EXPECTED OUTCOME

PROBLEM PLAN

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CLINICAL NUTRITION INTERNSHIP

Internship Report submitted in partial

24th April, 2023 - 27th July, 2023

INSTITUTE OF HOME & FOOD SCIENCES

Signature of the Student

Director/Chairperson Signature with stamp

actions and decisions in all aspects of life. I am privileged to express my heartfelt

appreciation to my esteemed academic supervisor, Mr. Mateen Ahmad. Your dedicated

their commitment to excellence in education and for fostering an environment of intellectual

the principles of knowledge, compassion, and integrity

2.5 GOALS AND OBJECTIVES OF INTERNSHIP................................................4s

TABLE 2.1: Rotation Plan..................................................................................................3

FIGURE 2.1 : Stadio-Meter.....................................................................................................11

Table 2.1: Medical Abbreviations & Acronyms

Medical Abbreviations and Acronyms

AS - Abdominal Surgery GERD - Gastroesophageal reflux disease

BS - Breast Surgery GFR - Glomerular filtration rate

EGD – Esophagogastroduodenoscopy HAV - Hepatitis A virus

GOO - Gastric Outlet Obstruction HBV - Hepatitis B virus

Pre-op - Preoperative (before surgery) HCV - Hepatitis C virus

Post-op – Postoperative (after surgery) IBD - Inflammatory bowel disease

Gynecology Ward: IBS - Inflammatory bowel syndrome

PIH - Pregnancy-induced hypertension AMI - Acute myocardial infarction

PG – Pregnant Aptt - Activated partial thromboplastic

2.1 BACKGROUND AND HISTORICAL FOUNDATION

Gulab Devi Hospital

2.2 DEPARTMENTS IN THE HOSPITAL

 Cardiology: Specialized in heart-related ailments and interventions.

3.1 DESCRIPTION OF INTERNSHIP

3.3 THE INSTITUTE OF HUMAN NUTRITION & DIETETICS

3.5 OBJECTIVES OF INTERNSHIP

3.5.2 INTERNSHIP CODE OF ETHICS:

Every student should follow the following SOPs strictly;

3.6 COMPETENCIES LEARNED DURING INTERNSHIP

3.6.2 Learned Competencies:

Figure 2.1 : Stadio-meter

Stadio-meter: it is used to measure height.

Figure 2.2: Mid-Upper Arm Circumference Tape

Figure 2.3: Image Courtesy (

Figure 2.4: Head Circumference Tape

Figure 2.5: Skin Fold Caliper

Figure 2.6: Flexible Segmometer

Flexible Segmometer: it is used to measure knee height when patient is unable to

Figure 2.7: Measuring tape

4.1 CASE INDEXING AND DESCRIPTION

Figure 3.8: ward rotations

PATIENT DATA (PEDIATRICS)

Nutrient Drug Interactions

%UBW - Bilirubin T. (mg/dL) 07 Low Social History Socioeconomic Geographical Occupation

Nutrition Intervention Therapy used

TABLE 3.7ELABORATED PEDIATRICS WARD CASE

Lunch  2  Boiled rice

PATIENT DATA (PULMONOLOGY)

Sr. Patients Medical / Concerned Nutritional Diet Order Nutrition Education

BIOCHEMICAL DATA (PULMONARY I & II)

failure, or renal disease or who are taking certain drugs

Nutrient Drug Interactions

%UBW 80% Bilirubin T. (mg/dL) - - Social History Socioeconomic Geographical Occupation

IBW (KG) 52 SGPT (u/L) - - Middle class Urban Labour (Husband) BL

Fluids (L) 1 1mL/Kcal

DIETARY INSTRUCTIONS(safe choices)

EXCHANGE CALCULATIONS AND MEAL PLANNING ACCORDING TO NUTRIENT DRUG INTERACTIONS

Food Groups Exchanges Carbohydrates Protein Fats Calories

Height (Feet/Inches): Energy Intake:__Kcal

Energy Intake:Kcal Energy Intake:Kcal